My-oh-Myo-Inositol

As I mentioned in a previous post about a supplement my endocrinologist recommended to me (when I outright refused to go back on Metformin), I'm going to give myo-inositol "The Old College Try."

Of course, he doesn't make dosing suggestions, which would have been incredibly helpful, and online sources say you can take up to 4 grams daily, relatively safely.  

So I did some preliminary reading, and decided to buy about a 3 month supply of Now brand Inositol--the formulation is myo-inositol. 

Last Wednesday, I started taking the supplement. I got the 500 mg capsules, and figure I'll take 500 mg daily, and perhaps gradually work up to 1 gram (2, 500 mg doses).

Wednesday I took the supplement in the afternoon with my 5.5 oz V8 and my usual B1, B2, and B6 supplements. Since Inositol is casually referred to as "Vitamin B8," I figure I should do what I do with my B1, B2, and B6 and avoid taking it with coffee.  Wednesday evening, I felt relaxed, almost washed out, but relaxed (as you'd feel after a particularly taxing day at the office).

Thursday morning, I awoke feeling a bit hung over or strung out, as you would taking an SSRI.  Thursday afternoon, I took the supplement exactly as I did the day before. 

Friday morning, I awoke with that same feeling. Later on in the afternoon, about 2 hours after I took the Inositol, I had that trembly feeling I get if I ate too much sugar. I wouldn't say I had tunnel vision, but I felt particularly nervous, and a bit queasy, JUST LIKE my blood glucose dropping. Luckily a co-worker had some Skittles, which I wolfed down, and once I got back to my desk I hydrated and ate something with protein.

Saturday, I had the brilliant idea to see how much the Inositol impacts my blood glucose. I dug out my glucometer, and decided to do some sticks:

Before Dinner: 85
2 Hours Later:  83

I'm not really sure what to think about this data! And perhaps now that I'm taking a dose before dinner, perhaps I should do a finger stick test again tonight, as well as in the morning, to see if it impacts my glucose upon rising in the morning.

And in the interest of being thorough, I want to see if taking this for a long period of time (1-3 months) elicits anything in the way of noteworthy weight loss.

So for the record, the starting weight I will use for this experiment will be: 205 (the weight at the foot doctor today--a weigh in for which I was not prepared!). 

Notes: Five days into this, and I feel like even a dose of 500 mg, 1x daily, impacts my anxiety levels--I feel very relaxed (almost lethargic, almost washed out), and no problems drifting off to sleep.   

Physician Fatigue, Part 2

I'm so damned fatigued about it all, every thing, I just cannot even muster enough GAF to type this out. But will persevere, if for nothing else, THOROUGHNESS.

Blah blah blah, two other pain doctors leaving me hanging, blah blah blah, rotator cuff, elbow tendonitis, blah blah... new pain doc October 2016, speculations about hip and back pain actually emanating from my knee, blah blah...

I started seeing my current pain doc in October 2016. I've gone through several weeks of trigger point injections in my neck and shoulder, left elbow and even down my IT bands of my thighs. It took us until DECEMBER to finally get around to doing the Synvisc shots in the right knee, which concluded up a few days before my trip to Hong Kong & India. The shots in the left knee commenced the day after returning from India.

In all honesty, I'm about 50% improved over how I was and have felt since 8/18/16, the day that set me into crisis mode. I'll take 50% over nothing, or 50% over how I was feeling. I'm now classified as "sub-acute" or "sub-clinical," however, the doc is making claims that it wouldn't take much to put me back where I was. And it's this claim/justification that I allowed her to give me a cortisone injection in my hip to help with the inflammation to the bursa.  

I'm no fan of cortisone--between my family predisposition to Type II Diabetes, plus my own Dx of Reactive Hypoglycemia, I want as little disturbance to my blood glucose as possible. 

Anyway, I am tired of visits every two weeks. Couple that up with this doctor's habit of "appointment creep," this is what I call it when a doctor insists on being late, making me wait anywhere's from 30 to 60 minutes. I *could* get an early morning appointment, and go to the office immediately after, but who knows if that means I'll be showing up to work a half hour late, or HALF A DAY late.  This makes it frustrating for me on a lot of levels to remain motivated and convinced that there is merit in going to this doctor.

Granted, she's made a huge impact in the hip pain. Huge. But as far as the unrelenting elbow tendonitis? Nothing. Physical therapy has provided ZERO relief. The day we did a cortisone shot in the elbow, THAT VERY DAY it was fine, but I suspect that was more a result of the local anesthetic used rather than the cortisone itself. The elbow isn't what I'd call excruciating pain 100% of the time, however, when the arm is at the full extension, right at the site of the medial epicondyle? OMG I cannot describe the searing pain.  

I've done everything imaginable to treat it:

Topical NSAIDs
Penetrex/arnica rub
Biofreeze
Ice/Heat
Compression
Physical therapy: Exercise
Physical therapy: Myofascial release
Chiropractic adjustments
Cool laser
Ultrasound therapy
TENS/EMS
Braces for carpal tunnel as well as elbow tendonitis
Behavior modification (discontinuing crochet for a full month or more)

ZERO relief.

There are only three other options, and none of which are covered by insurance:

PRP
EPAT
Acupuncture

I'm truly at a loss, and in pain, and I'm not convinced that more trigger point injections are going to help me with the elbow. And I have this prevailing sensation that the doctor is just trying to milk me (by way of my insurance) for as much as the insurance plan will allow.  

Not only am I planning on ditching my endocrinologist, but I'm also planning on "back burnering" my pain doc until June, when I have to resume the shots in the knees.  

I am at the point where I am overwhelmed and feel like a crazy person, just wanting to purge all of this out of my life. 

Physician Fatigue, Part 1

Plenty going on here, not sure where to start prattling...

January provided me yet another opportunity for travel, this time a side trip (three days) to Hong Kong prior to visiting family in south India. Despite being ever-so-careful IN India, I believe I picked up a gut-bug either during lunch at Hong Kong airport or perhaps something I ate on the flight. Within one half hour of arriving home, the diarrhea started, and took close to 2.5-3, plus two different courses of antibiotics (bactrim first, flagyl second) weeks to resolve.  

On an upnote, from beginning of the trip until current writing, I managed to lose 13 pounds, with 6 of the 13 being since arriving home on 1/22.

My Valentine's Day was a double-header: two appointments, 1. Bariatric guy; and 2. Endocrinologist. I must be a latent masochist, because both of these appointments were long-overdue, and both required a weigh in.

Bariatric guy seemed happy enough with my results, though of course pushing the idea of getting more active (which is something I am working on, first by getting a handle on my pain issues--see another post regarding this), and second by finding a pool that's local and has a schedule conducive to my work schedule.

In keeping with the previous appointment with the bariatric guy nearly 18 months prior, he seemed fixated on my symptoms of depression, and was too quick with expressing an interest in writing an Rx for phentermine or wellbutrin or... well, you name it. Each Rx promising magical weight loss--I've sworn off "the junk" since my bypass in 2011, and choose to manage my depression (or is this just my personality?), such as it is, in ways that are unique and suitable for myself and my needs/lifestyle.

The visit with the endocrinologist left me with the inescapable awareness that perhaps our doctor-patient-relationship has come to its natural conclusion.  

Last year, there was the issue of the two hour glucose tolerance test he should NEVER have performed. A test which had the potential to either leave me in a coma or dead, and just because neither of those things happened, this does not negate how dangerous that test was for me. Even my bariatric guy said, "He should have known better." Indeed.

Then this most-recent visit, with me showing (according to his records) an 8 pound weight loss, plus all my blood chemistry (minus my uric acid and my DHEA sulfate, both are elevated) ALL MY blood chemistry was pristine. No. Not just pristine. FUCKING PRISTINE.  I even showed my labs to a friend who is an MD and she showed it to a colleague (who is in integrative medicine) who said she has TEENAGE patients whose blood chemistry isn't this perfect.

So, 8 pound weight loss, plus pristine blood chemistry--what is to complain about?

Well, two things:

(1) For starter, the Endo informed me that despite the weight loss and the pristine blood chemistry, he wants to put me back on Metformin. Yes. A diabetes medication, despite the fact I am not diabetic, nor am I even BORDERLINE. See also: PRISTINE BLOOD CHEMISTRY.

He promised magical weight loss, and commented briefly on it helping inflammation--but nothing further, nothing conclusive, and no studies on PubMed were referenced.

Of course, I balked. The blood chemistry doesn't indicate I'm even remotely borderline for it, and my weight loss, all things considered, I cannot see where he justifies this. And I refused, and inquired if there was a supplement we have not explored or considered.

Long story short, I am incorporating myo-inositol in my daily regimen. He suggested it, but did not suggest a dosage. 

(2) Then there's the sordid matter of coin. I am a long-standing, established patient. I have been seeing him 3-4x a year for going-on-13 years. Each and every time there has been an increase in his office fees (he does not participate in insurance), there is no discussion ahead of time, perhaps when I am scheduling my next appointment, that the fees are going up. Each and every time, I am informed when I am settling up during the current visit.  His office fee now, I am ashamed to say, is $540. I remember 13 years ago, I paid close to $600 for just the consultation--and the office fees went from mid-$300+ on up to $540 where it is currently. 

I'm a state worker, and I'm not rich. And I've come to the point where I can no longer financially sustain going to this doctor. Not only the economics of money, but also TIME. Four times a year--that's a lot of visits, perhaps two visits more than is necessary.

I am in the same position I was in last January--left with the prevailing awareness I need to change doctors. Last year's OGTT was a red flag, and I rationalized staying on with this doctor given the amount of time and money I have invested. But now, the notion of him trying to strong arm me into taking a chemical that did nothing for me, and of course, being shaken down to the tune of $540 for each visit now, has left me feeling ... I don't know exactly how I'm feeling. It's complex. Vulnerable, foolish, angry, and at a minimum, I feel as if I can no longer keep my trust in this doctor. 

It might seem ageist, but he's in his mid-80s (to be honest, I thought he was closer to 90 or over), and perhaps I should just see someone else.

He touted his son-in-law being a "big deal" at a hospital system where most of my other doctors are, and his son-in-law is an endocrinologist too (though his focus I think is diabetes--and I want to go to someone who is an exceptional thyroidologist if such a thing exists). And given that the particular hospital system participates with my insurance, it's very alluring to think of spending $15 a copay, perhaps twice a year, versus what is now $540 for four times a year.   

But before I can even have the discussion wherein I ask for his blessing for me to have his son-in-law be my endocrinologist, I have to schedule a thyroid sonogram and FNA for the multitude of nodules on my thyroid.

This is the year I am downsizing. As much as I love my neurologist who I see for my migraines (which also seem to be managed and less frequent now), I want to consolidate doctors. I also see a neuro-ophthamologist for a weird collection of cells on my optic nerve, so if a neuro-ophthamologist can manage both concerns, all the better. 

I've hit my saturation point with this scenario and others, and am dedicating 2017 to minimizing and consolidating what doctors I can. Running hither-and-yon from one doctor to the next is not a lifestyle I want to perpetuate.