Health

You are currently browsing the archive for the Health category.

G.D. Update

July 28, 2011 in Health, Pregnancy | No comments

Well, the gestational diabetes class wasn’t as stupid as I thought it would be. The dietary advice was much better than things I had read on the internet for diabetics, and they did a personalized meal plan for me (based on my weight gain, the fact that I have twins, etc.) which is very close to how I actually eat. The only real difference is that I pay much more attention to timing and balance (and my body’s own signals), whereas the meal plan I was given was basically just a way of controlling overall carb intake. They do spread it out over the day (in three meals and three snacks) but there is no recommendation to also take in any certain amount of protein or fat, so there are suggestions like having a snack of fruit and a slice of bread. That would be a problem for me. Another suggestion would be to eat for breakfast, one egg, two slices of toast with butter, and a glass of milk. That much carb with that little protein would be a problem for me. Give me three eggs and I could handle two slices of toast if I really must eat them. But why must I eat them?

I was pleased to see that they didn’t make any distinction between complex and simple carbs. I suppose they would do so before putting someone on insulin, but by default, we were all allowed to eat white bread and rice and even have fruit juice, if that’s how we want to spend our carb allotments. They also didn’t ban candy or ice cream, just told us we had to count the carbs. Again, that works for me, as long as I have protein and fat in my system, too.

I did get a free blood glucose monitoring kit. (Well, I guess my insurance is paying for it – nice how I have absolutely no idea about medical costs, huh?) I’m supposed to test each morning and two hours after each of my three main meals. I’m also supposed to test my urine each morning for ketones, which will supposedly tell me if I’m drawing on my body’s stored fat. (I need to do more research on that. I don’t understand the relationship between ketones and low blood sugar, and I don’t understand exactly what the problem is, and whether it’s only a problem in pregnancy.) And I’m supposed to follow the meal plan and write down everything I eat and at what time.

But here is what I’m going to do. I’m going to do all the testing. And I might test more often as well. (I’m suspicious that my blood sugar is dropping in the middle of the night.) I’m going to record everything I eat. But I’m not going to follow the meal plan. I’m going to eat like I always do and see what happens. If I never have an elevated blood glucose level on my own diet, then why change it? During the class, we did a finger prick just to make sure we all knew how to do it. It happened to be exactly two hours after I had eaten lunch, which is the time I will be testing going forward. My blood glucose level should be less than 120. It was…ready? 67. And my level two hours after dinner? 76.

I go back in a week for the nutritionist to analyze my data. Maybe I’ll get more insight into hypoglycemia and how I can even better manage my condition after pregnancy. That would be wonderful. I also look forward to showing her how worthless and stupid that glucose tolerance test was in my case.

Well, that’s assuming I’m right and my levels stay low. But I’m pretty sure I’m right.

Fragile

November 29, 2010 in Health, Introspection | 3 comments

My latest MRI revealed that I almost surely do not have lupus, psoriatic arthritis, or any other systemic autoimmune disorder.  That’s great news!

What I do have is tendonitis.  I also have the equivalent of carpel tunnel syndrome in my ankle (tarsal tunnel syndrome), plantar fasciitis in my heel, and other inflamed areas around tendons and ligaments.  That’s all in my right foot and ankle, so we’re assuming that the pain in the other areas of my body is of the same nature.  Since I’ve had no injuries and I don’t overuse any of these parts of my body, my doctor thinks that I might have a genetic condition that makes me more susceptible to damage to my connective tissue.  Basically, I’m fragile.

This concierge physician I hired is finally starting to pay off.  The rheumatologist who ordered the MRI wanted to send me to a podiatrist for the foot problems and to a hand surgeon for my hand, and to specialists for every other part of my body that hurts.  She did not integrate the evidence.  My concierge physician did, and assures me that we will keep working to understand why this is happening so it can be treated in the most appropriate way.  He agrees with me that it is absurd to see separate doctors for each area of the body.  He and I agreed that the best step now is for me to go back to the pain specialist who performed my PRP therapy two years ago and get it done again.  It cured me for over a year last time, and the fact that it worked is consistent with this tentative and vague diagnosis.  I’m a little worried that I won’t have time to get it done before the donor egg process interferes, but I’ll find out in the next two weeks.

After that, the doctor wants me to have the genetic analysis he originally suggested.  His very first theory about my pain was exactly this (apparently there are rare but known genetic disorders that cause this kind of fragility), and I thought it was such a remote possibility that I didn’t do the tests.  I’m still not sure what it would get me to do the genetic testing – I mean, I don’t know if it would affect any decisions about long term treatment or management of my condition.  I plan to talk to the doctor more about that in a couple of months, as well as discussing what else might be causing this besides a genetic abnormality.  (The genetic analysis is expensive and not covered by insurance.)  For now, I’m just trying to get myself back to being functional without meds.

But I’m feeling a huge sense of relief since getting this diagnosis.  It’s somehow much less scary to have tendonitis than lupus, even though I really have no idea yet if my condition could be degenerative or have other long-term effects that are worse than lupus.  But knowing that my pain is the same thing that people feel when they have tennis-elbow makes it seem less mysterious and threatening.  I guess the real issue is that I have less uncertainty.  Not knowing what was wrong with me was such a huge source of stress.  Not knowing why it would get worse and worse was scary because I never knew where it would end – at one point I was convinced I would be bedridden in a hospital within months.  Now I know that it gets worse because I keep moving.  I can’t really live without moving, but at least I have a framework for understanding what is going on in my body, and I can develop a plan to deal with it.

I have to admit that I also have a sense of relief and validation that now I know that my doctors and others can’t write me off as a hypochondriac.  I’ve had crippling pain, with absolutely no evidence of a health problem, for years now.  I’ve had dozens of tests which, until now, have all been negative.  I’ve been told to consider what I deem to be irrational, non-scientific answers such as fibromyalgia (whose definition is essentially “mystery pain” and so means nothing) and leaky-gut syndrome (which claims to explain practically every ailment known to man, and so can not possibly explain anything).  I went by my own independent judgement and refused to accept anything that did not make sense to me, or which conflicted in principle with the rest of my knowledge, and I’ve been vindicated.  Even when I was wrong (by not following the concierge physician’s initial advice), I had good reason, and I ended up at the truth in the end.

It’s been a real strain on my self-confidence, though.  If I were Howard Roark or Dagny Taggart I might have been able to travel this path without self-doubt, but I have had a lot of self-doubt.  Coming to this place now is more than just a step towards physical health – it’s also a great lesson for my mental health.  I just spent three years trying to solve a problem and it seemed that at every turn, there was someone or something trying to convince me that I was deluded.  But, by persisting and relying on my own judgment, I did solve the problem.  Or, at least, I’ve begun to.  It’s a great boon to my self-esteem, which, lately, has been very fragile itself.

Lupus and Lipo

October 28, 2010 in Health, Pregnancy | No comments

For those of you who are just dying to be updated on my other health quest sagas, here is a quick report.

I’m not going to get liposuction until I’m sure I’m done with pregnancy. Both plastic surgeons I interviewed thought I’d be disappointed if I did it now.  And now that we’re going forward with donor egg, there’s no time, energy, or money for this project.

I repeated the bloodwork to test for lupus and everything remains negative. Since I found out that my fourth miscarriage was another trisomy, it is less likely that lupus is involved in my fertility issues.  And this means it is less likely overall.  Again, because we’re going forward with donor egg, I am limited on what kinds of drugs I can use, so empirical treatment is on hold.  I saw a rheumatologist but she was a terrible doctor.  I couldn’t get a word in edgewise so we never even discussed lupus.  I’m not exaggerating – this doctor never even found out what my pain symptoms are.  She had her own agenda and her own questions and she was a complete waste of time.  She ended up ordering an MRI of my right foot because that was the only place on my body she seemed to hear me mention as having pain.  After speaking with my concierge doctor, we agreed that I’d go through with the MRI since it’s been a long time since I did this, and it might provide some evidence of psoriatic arthritis (another suspect).  There’s not much else we can do while I’m working on getting pregnant anyway.  I just hope that I’ll be able to stay on the new NSAID (diclofenac) through the cycling process, and into early pregnancy if we get that far.  After that I might be in a world of hurt.  But I’ll deal with that if and when it comes.

Health Update

October 1, 2010 in Health, Pregnancy | 1 comment

So I’ve begun my quest to figure out whether or not I have lupus.

Here is the short version of the story: I talked to my aunt who has lupus to find out what her early symptoms were and how she was diagnosed.  She had more severe symptoms than I do, but the nature of the pain she had is remarkably similar to mine.  I’ve seen two doctors, and they are both willing to empirically treat me for lupus, but I want to wait to see a rheumatologist in mid-October before I make that decision.

In the meantime, I’m on a new NSAID for the pain and it is actually working!  I feel great.  I can pick up a glass of water with my right hand again, I can check my blind spot while driving, I can walk without being in agony, and I have enough energy to get through the day.  I don’t know why no doctor has given me this drug before.  It’s interesting that, without the pain, I also don’t have the fatigue or the stress that I had before.  Those symptoms usually go along with pain in these hard-to-diagnose cases, but it seems to be assumed that the stress causes or exacerbates the pain, and that the fatigue is a separate symptom.  I wonder if the pain is actually the cause of both of the others.

Then yesterday I finally got the results of the genetic analysis of the fetus from my last miscarriage.  It was trisomy 15.  Out of four miscarriages, we know for sure that two were genetic abnormalities.  This argues against lupus being any part of the miscarriage problem, which means that lupus is less likely overall.  Whatever happens with the lupus investigation, I have to deal with the miscarriages separately.  I could have more than one problem going on here, but since there is no real evidence of that, I’m leaning more and more towards being hopeful about donor egg.

To be continued…

Curves

August 23, 2010 in Health | 2 comments

I mentioned recently that my new doctor recommended moderate exercise to alleviate my pain.  I’ve not had a stable enough life situation to have any kind of regular exercise for many years.  I did a yoga class here and joined a gym there, but between having a baby, moving four times, and then being pregnant for two months, then not for two months, then pregnant again, then not, etc., I haven’t settled in to any routine.  And it was my last yoga class that coincided with the worst pain I ever had, so when the pain came back I decided to avoid physical activity as much as possible.

When I told the doctor this, he said it was possible that exercise might hurt more than help, but that I should give it a shot again.  He said that I should only exercise “up to the point of injury,” whatever that means.  I can’t even walk without pain, so it’s going to hurt, no matter how little I do.  I just took him to mean that I should not push very hard on those areas that give me trouble.  And having “doctor’s orders” to exercise is just what I needed, since I was really feeling like a slug and needed that to change.

So I decided to look for the right kind of exercise, but I had the damnedest time.  I looked for yoga classes, but there was nothing in the right time slots when Sam was in school.  Or there was, but only once a week.  What good would that do?  Working out on machines in a gym bores me to tears, and I hate having to wait for a machine and remember the whole set of things I want to do.  Anything outdoors is out because I won’t do it in hot or cold weather.  (Poor Toby has had about two walks in the past three months.)  Workouts on tape at home are good, but that takes a lot of discipline.  The sirens of The Little Things always beckon.  Swimming (indoors) would be perfect, but the transaction costs are too high – an hour of swimming seems to take three hours, what with all the changing and showering and wet clothes.

Then I remembered Curves.

I had used Curves briefly after Sam was born when I was told that exercise might help with my mild post-partum baby blues.  I have no idea if it helped because I had to quit just a couple of months later when we moved from Michigan to San Diego because Adam became too busy at work to watch Sam even for a few hours a week.  (Curves does not have babysitting services.)  And the hell of moving and living out of boxes with a 10-month-old (and a mostly absent husband) made me much crazier and angrier than I had ever been due to hormones.  Or maybe it was the hormones that made the moving such hell, or maybe it was that I stopped exercising…but I digress.

Curves is a place filled with little old ladies with short, puffy white haircuts.  It’s for women only, which I guess matters to some people.  I could care less.  I guess the old ladies are there because you can do the workout in just about any physical condition.  The little old ladies probably keep out the younger set, but I think that is a big, secondhanded mistake.

Curves is a circuit of about 15 strength-training machines, with cardio stations in between each.  You arrive at any time you want and jump into the circuit at any point.  You use a machine for 30 seconds, then you do whatever cardio activity you choose (running in place, jumping jacks, leg lifts, squats, etc.) for 30 seconds.  Then you move to the next machine.  And so on.  There is lame but bouncy music on in the background and a voice-over that tells you to “change stations now” every 30 seconds.  You do two circuits, then you stretch.  The recommended stretches are posted up on a wall.  The whole thing takes about 35-40 minutes.

What I like about Curves the most is that you don’t have to think about it at all.  The first time you go, you need about 10 minutes of instruction on the machines, and that’s it.  (If you want more coaching, I think you can get it.)  After that, you show up and go. There is nothing to calculate, measure, or count.  Once you get in the groove of it, it becomes very routine.  I suppose this might get boring for some people eventually, but I’m pretty good at setting my mind to thinking about other things, so I find the time at Curves to be doubly productive.

Also, the workout is as intense as you want to make it.  If you want intense, you push yourself to do more reps in the time allowed, and you do something difficult for the cardio.  You can also “double up” on the machines or do more circuits if that floats your boat.  I’m sure fitness fanatics scoff at this, but if your goal is simply basic exercise for general heath – cardiovascular fitness, strength, and flexibility – I believe this workout can be challenging enough for anyone.  The only exception would be people who simply can’t focus independently without an outsider pushing them.  Plenty of the little old ladies at Curves push lazily at the machines and walk in place as they gossip and chatter and never break a sweat. But Curves has a solution even for them, if they choose to use it.  Every 10 minutes or so, the voice over prompts you to “move away from your station and find your heart rate.” Then a 10 second count is marked for you so that you can calculate your heart rate.  Another poster tells you what your target heart rate should be for your age.  How easy is that?

I like that the workout is fast, and that I can go at any time on any day.  I can drop Sam off at school at 9, go straight to Curves, come home and shower, and be done by 10:15.  That leaves me an hour and a half of continuous me-time before I have to pick Sam up.  A formal yoga or cardio class might start at 9:30 or 10 and go for an hour, which would leave me a few minutes on each end.  Great, more fractured time – just what I need.  (Now, during the summer, Adam stays home with Sam three mornings a week so I can go.  It really was a difficult and unusual situation when we were living in San Diego.)

The Curves workout is also compatible with pregnancy, so I won’t have to drop it when the time comes – or comes and goes, as the case may be.

I’ve modified my Curves workout for my pain situation.  I realized that jogging in place was making the pain in my feet worse so I switched to low impact cardio only.  Usually, I do the elbow-to-knee crossover leg lift, if you know what I mean.  One of the machines put a lot of pressure on a tendon in my arm that was sore, so now I skip that machine and double-up on the next one, which happens to be one that I need more work on.  I think I’ll want to add in a bit of extra abdominal work once I’m in better shape and I always do extra stretches because having a strong core and being limber are helpful in many situations involving pain.

The Curves franchise is HUGE.  There are Curves everywhere!  When I travel, I can go to the local Curves if I want.  There always seems to be one nearby.

I have to admit, I also kind of like the little old ladies and the gossip.  There is a friendly, non-competitive culture at Curves, and it makes for a more pleasant workout.

So, laugh if you will.  I get the feeling that Curves is seen as an “exercise for dummies” kind of workout.  But my firsthand judgment tells me otherwise.

Concierge Medicine Update

August 9, 2010 in Health | 3 comments

As reported earlier, I hired my concierge physician back in April and had my annual physical in May.  This was my first physical in at least 15 years.  I had all kinds of blood work done and had my first EKG. Everything was normal, which is great, but also frustrating, since my mystery pain has come back with a vengeance.  I have pain in both feet (my right toe and ankle are visibly swollen), my right thumb, my right elbow, and both hips.  The pain is not extreme, but it makes walking (and writing with a pen or pencil) very difficult, and the constant pain just wears on me.

So far, I’m a bit disappointed with my doctor.  He has definitely spent more time with me than a regular doctor would, and I’ve spoken to him on the phone a few times, which is unheard of in a regular practice.  But I don’t get faster appointments or less wait time at the office, as promised.  I had my physical over two months ago and I’m supposed to get a CD with the results on it, but still haven’t received it, so I have nothing at all in writing.  (I can’t wait to tell you how my cholesterol levels have changed since I rejected the low-fat Standard American Diet in favor of red meat and fat!) And this doctor is as stumped about my pain problem as every other doctor.  His only suggestions so far have been to get moderate exercise and to have a genetic analysis done.  The exercise does not help and might even make things worse (but I’m loving it for other reasons and so will keep doing it, as I’ll write about soon).  And after doing some research, I think the genetic analysis is a dead end and my doctor can’t give me any coherent reasons for doing it.  The fact that he suggested it makes me distrust his judgement a bit, but at least he did have a discussion with me about it, and he respected my position and didn’t push it.

I know that medicine is still a young science and we can’t get answers for everything, but even I can think of many other things to try for my pain.  In fact, I’ve found something that seems to be helping that not a single doctor has ever suggested: ice.  This is the first time I’ve had visible swelling with my pain, and when something is swollen you ice it.  Duh.  I’ve been using ice and cold compresses on my feet for the past two nights and this morning I was able to walk straight down the stairs – as opposed to going down sideways or backwards – for the first time in a couple of months.  If I can solve this with ice instead of the painful and expensive PRP therapy, I’ll be thrilled.  Also, the fact that the pain responds to ice might tell us something about its cause.  If I had a regular doctor, I’d have to make an appointment to tell him about the ice and assess our next action, but with my concierge doctor, I can just call him.  I only need to go in if he needs to see me or run tests, and that is a benefit.

So, overall, I don’t know that I’m getting my money’s worth, but I am getting some benefit.  (I also got a referral from him for a dermatologist who seems much better than my old one, so I suppose that’s something too.)  I don’t know if I’ll continue with this doctor after our one year agreement.  It might be worth it for continuity’s sake, but it might be better to just put that $1,500 per year into my FSA and opt-out of socialized medicine altogether by not using my health insurance.  I think if I could stabilize my health, that might be the better option.  I’ll assess that when the time comes.

I know many of my readers have been interested in my experience with concierge medicine, especially considering the state of health care at present. For more information on how to protect and maintain your health in an irrational society, I highly recommend Dr. Paul Hsieh’s article in the Summer, 2010 issue of The Objective Standard: How to Protect Yourself Against ObamaCare.  If you don’t have a subscription to TOS, you can buy the article a-la-carte at the website.