Best Endocrinologist Ever.

Every time I have an appointment with my endocrinologist, I hem and haw about whether I should cancel it. It’s on the other side of town, $50 round-trip in an Uber, it only ever lasts about 20 minutes and couldn’t she just look at my thyroid lab results and email me about whether to stick with my current hormone dosages? Well, each time I go, I am so grateful for this doctor (last week I told her nurse I would walk on hot coals for Dr. B) and I vow to come straight home and write an update so I can remember everything she said. I never have managed to do this and the visit summaries hardly mention anything at all, so today I’m going to write a general update of her treatment.

I’ve seen a lot of endocrinologists in the last six years and they have all, without exception, been kind of odd, stoic and monosyllabic. Until Dr. B. She’s vibrant and engaged (after seeing her, I always mourn my lack of brain energy a little more), listens closely, talks about her ideas out loud, thinks outside of the box and is interested in conditions not typically related to the endocrine system. Imagine that: a big hospital allopathic endocrinologist taking the whole body into account!

The first time I saw her a year ago, I told her my basic story (anaphylaxis 2001-2002, vasovagal collapse 2005-2011, thyroid goiters 2009, radioiodine ablation 2010, SICK 2011), assuming she’d check my thyroid and update my prescription as per usual — and she did, but she also ordered pituitary blood tests, a Cortrosyn stimulation test (CST) (otherwise known as an ACTH stimulation test — it measures how well the adrenal glands respond to ACTH), referred me to two neurologists — one that specialises in headaches and one that specialises in dysautonomia — and said we would consider placing a continuous glucose monitoring device to assess the drops in my blood sugar (good news is, my blood sugar crashes got much better, possibly because I am eating all foods again and have put on weight). No other endocrinologist had ever suggested any of these things.

I was dreading the CST because of my reactivity and intravenous injections of anything don’t allow me to start low and slow, but it was fine. I did my research beforehand (yes, they were they only using 1mcg of Cortrosyn; no, I didn’t need to fast; no, it didn’t need to be timed according to the follicular phase of my menstrual cycle; no, I didn’t need to be off bioidentical hormones; and, yes, my husband could be with me), so I felt comfortable about the procedure and the results were normal.

The pituitary testing showed low LH (luteinizing hormone), DHEA and IGF-1. Because of the latter, at our next appointment Dr. B ordered a pituitary MRI to “leave no stone unturned” (LOVE her). The MRI was normal, but she emphasised that it was less reliable because of my unwillingness to use contrast (I didn’t think the risks of a reaction outweighed the benefits of a better MRI — and she was ok with that). She also gave me a prescription for Florinef to see if it would help with my hypotension (blood pressure was 80/60 at this appointment). I trialed it for a month (starting at 0.0125mg (!!), working up to 0.1mg) and thought it might be increasing my headaches (but not my blood pressure, of course), so I stopped, but it’s still on my list to retry.

My thyroid levels have consistently been tanked for the last 6 years and at every appointment Dr. B would tweak my meds. I’ve gone from 50mcg/day of levothyroxine to 100 to 125 and from 5mcg/liothyronine to 10 and — this is exciting — when I told her my naturopath suggested much higher T3 and lower T4, Dr. B said, “I’m totally open to that, let’s try it.” 😮 Typically allopathic endocrinologists and NDs do not see eye to eye on treatment and optimal thyroid levels and often one doctor will be resistant to another doctor’s suggestions, especially when the suggestion comes from someone who isn’t a specialist. Dr. B has no ego getting in the way. So, we increased my T3 to 15mcg twice/day and lowered T4 to 100mcg. I really don’t know if it has helped, but she seems more satisfied with my thyroid levels. She told me to watch out for tremors, heart palpitations and insomnia, but they are all within my normal constellation of symptoms, so who knows (although, as I’m typing this, I realise that my quite-vicious nightly palpitations haven’t happened in a while– maybe weeks). She diagnosed me with “euthyroid sick syndrome” which essentially means your thyroid will stay sick until the underlying chronic illness gets better.

I saw a headache neurologist and a dysautonomia specialist (more on both of those in separate posts), but neither of them were the ones to which Dr. B referred me. And — another reason to love her — she had no problem with that and was still interested in what they had to say. Even better, when I told her the dysautonomia specialist didn’t have much to offer and essentially told me just to make sure I don’t decondition any further, Dr. B raised her eyebrows in surprise and kind of dismissed this, still interested in helping me fix this piece of the puzzle (those of you that haven’t done the doctor rounds might not realise that almost all of them tell you to simply exercise more (or gain/lose weight) (or take antidepressants), so I expected Dr. B to take the specialist’s assessment as bible and agree that I was just deconditioned). She suggested I do a growth hormone challenge (it involves a 17-hour fast, an 8am check-in and a 5-hour test where they give intravenous glucagon and then measure human growth hormone (HGH) response through blood draws) and said the worst side effect she’d seen was vomiting. I wanted to vomit at the thought of getting to a hospital at 8 in the morning. I went home to do some research; that was in July of last year.

When I saw her again at the end of September, I hadn’t done the HGH challenge and she didn’t give me a hard time at all. Three months after that appointment I still hadn’t found the nerve, so I emailed her a long message about my glucagon fears (those of you with mast cell/anaphylaxis/medication sensitivity issues can read my email* below for the reasons it gave me pause) which any other specialist would either not answer or reply that I should come in for an appointment to discuss. Instead, she sent me a very thoughtful, validating reply (not “For fuck sake, stop being such a scaredy-cat and do the bloody test since I’m the one doctor who is investigating all these things!”) and offered an alternative to glucagon — an insulin challenge test — which I agreed to … and then never did. They give you intravenous insulin, drop your blood sugar to 40 and then test HGH. I told her I was more comfortable with the devil I knew (hypoglycemia) then the one I didn’t. But, it turns out I’m not really comfortable with voluntarily meeting any devil. I’ve had my blood sugar drop into the 40s. It was absolutely horrific — one of the worst feelings I’ve ever felt. And, although they give you intravenous glucose right afterwards, I still couldn’t bring myself to do this test and subject myself to the crash when I thought they probably wouldn’t find anything.

So, I waited until my appointment this month — 8 months after she first wanted to investigate this avenue — and told her of my fears about the insulin challenge test as well. I expected her to just give up, to say there’s probably nothing wrong there, anyway, but she didn’t. She said there was an additional reason to do the insulin challenge (other than for HGH output) and that was that it can pick up a hypothalamus issue that the glucagon stimulation test can’t. Ok, I can get on board since it’s a two-fer. However, in another display of out-of-the-box-ness and medical generosity, she suggested I just try HGH injections without doing the challenge test. She said she had two other patients with the dyautonomia-mast cell-EDS trifecta (more on my EDS diagnosis at another time) and, even though neither one flunked the stimulation test, they tried HGH and had really good results. A friend of my sister-in-law’s had a lot of success with HGH and it has always been in the back of my head as something to try when I win the lotto. I read it cost thousands of dollars, but Dr. B’s prescription is “only” $138/month, so I’m on board. If/when I get the nerve, I can stop the HGH for a week and do the challenge test and, if I fail, insurance will pay for my prescription. An added bonus is my nurse who comes to my home every week (to give me intravenous fluids with my immunoglobulin infusions) can show me how to subcutaneously inject the HGH and I don’t need to go across town for a tutorial appointment.

Gratitude for good doctors! Wish me luck with the HGH.

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Thanksgiving Tsunami

The last 10 days have been a bit harrowing. Different symptoms crashing down like waves each day. First let me tell you about our early Thanksgiving dinner with just the two of us.

Everything was made from scratch with the freshest ingredients. The only thing we didn’t do is grind the almond flour ourselves. Here’s what we had:

The turkey was pastured, free-range, organic, fresh (not frozen) from Rain Shadow Meats, our specialty butcher here in Seattle. They had 400 turkeys in a truck parked outside their shop and my husband tells me it was a chaotic scene picking it up. The smallest bird they had was 12 pounds and we didn’t want to store it, waiting for Thursday because of histamines, so we put it in the oven as soon as my husband got home. He roasted it upside down, so it’s a funny looking photo (and these aren’t the greatest photos becasue it was dark in our house):

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I eat roasted root veg and mashed sweet potatoes and Brussels sprouts and other green veg all the time, so I decided, for a treat, to have a “stuffing” and cranberry sauce to go with my turkey, while my husband made himself potatoes and corn. The stuffing was based on Mickey Trescott’s recipe, but I left out the mushrooms and cranberries. I added fresh rosemary, parsley and a few cut up dried cherries for a zing every few mouthfuls. I also made a paleo “cornbred” (no corn in it, but it has that grainy quality from the almond flour) and added cubes to the stuffing becasue — stuffing without bread in it? Really?

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The bread itself was delicious and I had a piece slathered in butter, while my husband got to eat those soft, squishy pull-apart rolls that I love so much.

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I also made cranberry sauce from fresh, organic cranberries, fresh ginger, apple juice, orange juice and a touch of honey. I have never made cranberry sauce before and had no idea how easy it was. Why would anyone buy it in a tin?

IMG_20141123_184912 The gravy was made from chicken bone broth, herbs and onions. You blend it with a hand blender and the onions thicken it.

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All in all, it was a lovely meal and would have been even lovlier if we had been surrounded by friends and family and laughter and chatting.

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Then the tsunami hit.

12 hours after I wrote my last happy, chatty post, I awoke from sleep at 3am, the sickest I have ever been in my life. I know there’s a lot of “sickest I have ever been”s in my world, but this truly was. Not once, in 3 years of ME, when all my worst symptoms happen at night, have I woken my husband to help me. Well, Sunday night, I had no choice. I crawled on my hands and knees to the toilet, shaking violently and drenched in cold sweat. Cold sweats are diffferent than the night sweats I experience. They are what happens right before I collapse with vasovagal syncope. So, it scared me. I thought I was going to lose consciousness at any moment and I was so parched I needed water asap. I crawled back to the bedroom and got my phone and woke my husband sleeping downstairs. He got me water, salt, my blood sugar tester, my blood pressure monitor, thermometer, charcoal and Benadryl. I didn’t know what was happening, honestly. How could this be a reaction to the healthist and freshest Thanksgiving dinner I’d ever had? What has happened to my body that I now react to anything random?

All my vitals were low, but not low enough to be causing the sickness. Once again, I felt poisoned, only this time I hadn’t taken Cromolyn or any other new drug or supplement. My gut told me it was the onion gravy. It was a lot of onions and I know I have digestive issues with raw onions. It could have been a reaction to the onions themselves or it could have been a form of sulfur poisoning. The meal was very sulfur-heavy and I know my CBS mutation* causes problems because it’s shown up in my ammonia, taurine and homocysteine blood tests.

Yes, when it comes to histamine, it could have been the small amount of orange juice in the cranberry sauce or the few dried cherries or, if you belive my nutritionist, the caulifower in the stuffing, but I don’t think so. I eat dried fruit every day and I’ve eaten an orange without problems. Besides, it didn’t feel like one of my histamine reactions. It was much, much worse. If it wasn’t onion/sulphur poisoning, I would say it was the almond flour. I have reintroduced almond butter, but not almonds themselves or almond flour.

I never got back to sleep that night and rested carefully the whole of Monday. After saying in my last post that no matter how I’m feeling I make it to see my physical therapist, I had my husband call and cancel our appointment that day. I ate like a shaky, poisonened sick person, trying to choose foods that would have the least impact on my body in every way,  but this started the next symptom wave: blood sugar issues. I had rice, carrots, cucumber and sweet potato for breakfast. My blood sugar was 70 before I ate and 170 an hour after I ate. I had a chicken salad, parsnips, butternut squash drenched in butter, but stayed away from the chips and chocloate and broth I eat every day.

Tuesday, I was 2 pounds lighter — after one day of not eating the high-caloric crap I snack on to maintain my weight. And my blood sugar continued to crash. After years of hypoglycemia, I can usually feel the shakes when my sugar drops into the 70s, but it dropped into the low 60s a few times before I caught it. I increased my protein and starchy veg, I added olive oil, plantain crackers, fresh herbs and lots of pomegranate. I even had to go downstairs to the kitchen at 1am, after I had brushed, flossed and had my mouth guard in to cook up a beef burger and sweet potato. Exhausting.

Wednesday, I felt more stable, but very ME-ish: a bad headache and my spine and muscles felt infected and swollen.

Thursday (Thanksgiving) brought on the next new symptom wave: my blood pressure kept tanking alarmingly. No matter how much salt I ate or electrolytes I drank, with legs up and compression stockings on, it would not come up and stabilise. The best I achieved was 83/55.

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My Riley always knows when his Mama isn't feeling well. <3

My Riley always knows when his Mama isn’t feeling well. ❤

This continued on into Friday and, then, towards the end of that night, my whole body was in pain – joints and muscles – which I haven’t experienced in quite a while. My back and my hands felt arthritic.

Saturday, my blood pressure was better, but then came the sore throat and hoarse voice, making it difficult to talk. That night, I awoke 3 hours after going to bed with night sweats and never went back to sleep.

Sunday came a wave of neurological symptoms: poor cognitive abilities, worsening tinnitus, slurring my words, weak muscles, droopy eyes, my numb “buzzy head” symptoms (which signal I need to basically ctrl+alt+delete my brain immeadiately) and a cracking headache.

Monday, my throat and head pain had ebbed, but now it was my heart’s turn. It was hammering all day and fit to burst whenever I moved.

These last few days have been menstrual hell, which is generally an increase in my typical ME symptoms. I would honestly take all the other (probably more dangerous) reactions over the ME-inflamed, painful, exhausted days that feel like someone has pumped every muscle full of poisonous led…  These are symptoms I can’t fight through. There is no remedy, no relief. They make me feel like I cannot go on living if they are prolonged and they affect my mood horribly. I can’t see the light at the end of the tunnel, and I get scared and weepy.

But, the good news is, today I’m stiff and crampy, but better, although the insomnia and nightmares have continued all week and I’m in desperate need of a decent sleep. I’ve been eating a very low-sulfur and low-histamine diet since the sickness that kicked this all off and am completely fed up with squash, lettuce, sweet potato and parsnip. My kindom for some kale! Never thought I’d say that. I tested the turkey, turkey bone broth and orange with no reactions. I tried the almond flour bread, but it was inconclusive (this time of the month caused confounding variables), so I might try again next week. I ate a lot of almond butter with no problem and, today, I had cauliflower (my first sulfurous veg in 10 days) with no problem. I still have to try the stuffing and cranberry sauce, but continue to suspect the onion gravy. Such detective work!

The even better news is, we managed to get out to the cemetery for half an hour to watch our pups run in the thin dusting of snow (yes, SNOW!) and, for that, I am truly grateful.

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Onwards and upwards. I hope things will ease up until after Christmas.

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*”Increased CBS enzyme activity would act to convert homocysteine more efficiently to cysteine, thereby lowering homocysteine levels. Ultimately individuals with the CBS C699T upregulation of the CBS enzyme can generate more sulfur breakdown products with potential sulfur toxicity issues, enhanced ammonia production, and a lack of glutathione.” ~ Dr. Amy Yasko’s book, “Genetic Bypass”

Good Morning, Heartache

What happens when a healthy person has an air purifier in their bedroom that begins to rock ever-so-slightly in the night? What about when they have a bit of a leak from their cpap? What about when the temperature in the bedroom goes up to 75 degrees? What about when the dog stretches and his nails graze the wall? What about when a line of sunlight creeps under the black-out blinds? What about when someone dares to take a step two floors below their bedroom? Probably nothing. Probably, they keep sleeping soundly. If they wake, they probably go back to sleep fairly quickly. It probably doesn’t even register.

What happens when a person with M.E. experiences these things?

This:

Zeo graph from 1am-9am showing constant "wake" (top of graph).

Zeo graph from 1am-9am showing constant “wake” (top of graph).

 

What happens when a healthy person only gets 2 hours of broken sleep? They are very, very tired.

What happens when a person with M.E. experiences this?

Heart racing, difficulty breathing, muscle pain, extreme stiffness, dizziness, reemergence of migraine, very blurry vision, difficulty forming coherent sentences, loss of appetite, inability to get out of bed, panic. And that’s only in the beginning of the day.

 

Stop haunting me now
Can’t shake you, no how…
Good morning, heartache, sit down.

Ghosts in the Machine

Yesterday, my acupuncturist said, “This session should make you very relaxed and tired and you should sleep very well.” That prediction actually seemed to be true until 5am when the ghost in my room pulled and released the window blind and woke me up like a flash-bang detonated next to my head. I had been sound asleep, dreaming about Janis Joplin of all people. It’s one of those spring-loaded, black-out blinds and the sound of its uncontrolled retraction ricocheted off of every surface in the room and bounced around my cranium like a high-speed destructive bowling ball. After figuring out where I was and who I was and what had happened, I regained control of my fight-or-flight panting and was able to release my fingernails and toenails from their death-grip in the ceiling plaster. I lay down, trying to go back to sleep, but I knew that sun would come streaming in soon and I wake up from the glow of an alarm clock, so I had to make a move.

I stepped onto the chest below the window (climbing Mount Everest) and reached up in the dark to try to get a grip of the end of the blind, but it had wound itself too tightly to get my fingers behind an edge. Then I realised I was standing in my bedroom window naked and, if someone happened to be out there in the garden or my neighbour happened to have insomnia and was gazing out her window, they were getting an eye-full. I stepped down off the chest, put on my robe and climbed back up (Mount Everest again). After fiddling with the blind from every angle, I knew I wouldn’t make it budge without some sort of pliers to grip the end. I was also still shaking from the adrenaline and sweating from the exertion of standing up out of bed, climbing, reaching above my head… So, I gave up and went searching for my eye shades. Of course, they were in none of the usual places. I went into my meditation room and found my dusty back-up pair, knowing all these lights on and this rummaging was waking me up more and more. And worse: the dogs downstairs would think it was morning and, once they’re up, I’m screwed. That’s a combined total of 170lbs of hunger.

Back in bed, I lay trying to sleep for about an hour and, just when I was drifting off, the Rascally Robin started pecking at the window in our living room. I keep hoping it’ll stop and I keep forgetting to do something about it during the day, but EVERY MORNING AT AROUND 6AM this robin starts attacking his reflection in our window. I realise this wouldn’t wake up 90% of you ~ it’s a window on a different floor, for god’s sake ~ and I tried so hard to talk myself into believing it was just the soothing clickclack of a branch in the wind, but it didn’t work: I would start to drift off and it would wake me up every few minutes. Over and over. Torture. SO, I got up and closed my bedroom door. I know, this seems like an obvious remedy ~ something I should always be doing ~ but a closed door in our house is like a dog whistle. I could lie in bed all day with the door open and neither dog would have any interest in coming in, but, close that door and they are behind it scratching, whining and pacing back and forth, sure they are missing out on some awesome adventure.

Sure enough, as soon as I closed the door, got back in bed, put my eye shades on and settled down ~ just long enough for me to do all those things ~ there was a scratch on the door. And then a whine. I got up, let my dog in, let him on the bed, told him to shut up and then we both lay down and listened to the Rascally Robin pecking on the window downstairs. When it got a little louder, my dog started to get interested. He started doing that “aa-FUH” thing that dogs do ~ that half-bark puffing air through their lips. So, I started looking for the earplugs that my husband had gotten me ages ago. Up out of bed, rummage rummage, back in bed. The little packet only had one earplug in it. Not joking. Up out of bed, rummage rummage, got second packet, back in bed, insert earplugs. Now, picture this: cpap mask, medical tape over my mouth, my Zeo headband, earplugs and eye mask. Seriously?

The thing they don’t tell you about earplugs is, if you lie on your side in half-sleep and feel something burrowing into your ear, you wake up. Because that could be spiders or earwigs or ticks, oh my! The other thing they don’t tell you is, earplugs HURT. They make your ears ache. They make your head ache. Especially if you have the wee-est ears in the world, like I do. If I were watching, say, Led Zeppelin play a concert, I might not notice the ache. Or, at least, it would certainly be worth it. But, lying in the lightening room, feeling exhausted and traumatized, it began to feel like someone had filled my eardrums with ever-expanding putty. And, although I couldn’t hear the robin anymore, I was suddenly enveloped in my OWN noise. My bed was a sensory deprivation chamber. My gurgling stomach sounded as if it were amplified through a long pipe into my brain. My heart was like the drug smuggling airport scene in Midnight Express. The hum of the cpap and my metronomical breathing were like Dave in the spacesuit trying to change to manual controls, while Hal sings, “Daisy, Daaiseeeey…”

Just as I convinced myself this was soothing, womb-like and I could deal with the earplug pressure, my 105lb Rhodesian ridgeback jumped off the bed, went downstairs and rang the bell hanging on the front door ~ his signal to go out. And then he rang it again. And again. I knew, however, this was a call for breakfast. He didn’t need to go out. The cheeky bugger was trying to get me downstairs to feed him. I ripped the tape off my mouth and yelled, “GO TO BED!” It worked for about half an hour and then I heard my husband getting ready for work. I called it quits at 8:30am.

My sleep graph: the top line "W" = Wake

My sleep graph: the top line “W” = Wake

I did not embellish any of this and, although, I’m really trying to make it into a comedy, it devastated me. After all these weeks of horrible sleep, to be roused permanently from such a nice slumber after 5 hours, feels so unfair. When I came downstairs, my husband told me he was getting up at 6:30am tomorrow morning (a Sunday) because of the clocks going forward. I burst into tears.

I’ll try valerian for a week or two, but, if it doesn’t help, I’m moving on to brain chemical-altering, heavy-duty drugs. End of story. I thought I could will my sleep better, but this is beyond my abilities. I hope I haven’t caused permanent damage.