Kaizen: Day 272

Thanks to my travels last month, I have backslid ENTIRELY. I have not been on my bike in about 34 days.

I thought while I was in India, I'd use the exercise room at my in-laws' apartment complex, but that would've involved an escort, and it was too damned hot and humid for me to consider expending any additional energy. 

While In India, I did manage to get an aryuvedic massage at the ashram I was staying at in Kumbakonam; and I later went to an aryuvedic doctor in Madras to hopefully get some solution/s to my chronic pains. So there's that--I managed to do SOMETHING towards my goals, but in the meantime I backslid entirely. 

Then there was Thanksgiving, and work, and no real amount of downtime for me to recover from everything, and here I am 34 days and no bike.

I've set two alarms: one in the evening with a reminder SLEEP HYGIENE! to hopefully motivate me to get out of my heated zero gravity chair and brush my teeth and take my meds and set up some things for the following day, and hopefully get into bed by a decent time (no such luck--I ignore this alarm every damned night); and one in the morning at 6 a.m., hoping one day I'll just "Five Second Rule" myself out of bed and onto my bike.

Couple all this up with the fact I haven't talked to my therapist since the third week of October, and since he's going through chemo it is doubtful/unlikely/uncertain when (if at all) I will speak with him again before the year is out.

But come January, I will be seeking out a new therapist to hopefully help me work through and manage my schemas, and hopefully help me with my mindset.

That all said, despite not getting out of bed this morning, I did manage to hit the snooze alarm--and I used my resistance bands and started back into THAT routine. Hopefully I'll be motivated tomorrow to do it too. And with any luck, maybe Saturday I'll get back on the bike. Maybe.

Kaizen: Day 258

I have backslid 100%.

Prior to our recent trip abroad, I had something horrible/challenging happen to me at work, which ended up depressing me. However, something useful did come of it all, and I've decided to find a person who specializes in schema therapy.

Then our trip abroad effectively gummed up the works and got me 100% off my schedule regarding my bike.

Despite that, while we were away, I did manage to go to both, an aryurvedic ashram, and another aryurvedic clinic while we were away, where I received aryuvedic massages, and at the second place, supplements and exercises to help facilitate some change in my collection of pain issues.

Only time will tell if it will ultimately help.

And Thanksgiving will be here in "one day and a wake up," so there's no chance of getting back in any kind of routine until AFTER the holiday. 

Next month, I have three appointments set, and hope to get some good news from my kidney guy--good news in the form of a discussion that goes thusly, "Okay, tell me what you're doing differently." I feel like I'm battling an invisible dragon in regards to my protein levels in my urine.

Anyway, more to report in a couple weeks or so (I hope).

Not That It Matters

And I doubt it heavily, whether anyone reads this blog, though I DO blog for my own self, purposes and record keeping...

I am becoming increasingly more depressed.

Between the ongoing pain issues that won't resolve themselves fully, and dealing with some family bullshit head on, and everything else I listed in my litany yesterday about how my August has been off-kilter, I'm depressed.

I ditched Facebook finally last month, and that has cut down/damn near eliminated my online socializing completely. So rather than feeling shitty about seeing friends interacting with other people and not responding to message I've sent them, I now am feeling shitty about the void, the abyss, the abject lack of give a fuck by people I considered friends.

I updated my contact list before ditching FB, and I am actually going to identify which people I remain in contact with, and adjust myself and my expectations accordingly.

Surely, I expect too much from people. This is the far better thing to think rather than to think that so many people were just superficial/casual acquaintances (with 1-2 shared common interests) rather than actual friends. 

This isn't a boo hoo attempt at attention whoring. I am physically and emotionally drained, so everything else gets analyzed and perhaps exaggerated a bit as a result. 

Kaizen: Day 173

Maintaining 30 minutes on the bike daily. Though for a while there, I was setting an alarm to get up by 5:55 every day, and was knocking out an hour a day, Monday-Friday. Then I dropped down to Monday, Wednesday, Friday. 

For the last few weeks I've been very flat, perhaps even depressed. Of the litany of reasons why my mood is bottoming out might be:

1. August's heat and humidity.
2. Spending the majority of the month without my co-worker who sits closest to me (who is the first person I see daily and is a very positive person). 
3. I have been on Jury duty for the last few weeks. 
4. I told off a petty, trouble-making relative.
5. I turned 50 this month.
6. Or it might be a combination of these things. 

Also worth mentioning, that for the entire month of August, my physical therapy appointments which normally are on Saturday mornings, had to be moved to Tuesday nights this month, because my physical therapist isn't available--and this really threw a monkey wrench into the structure of my Saturdays, as my physical therapy appointments were the catalyst to get me out of the house, and into motion do do doing things. So my whole routine has been off, and I just feel wiped out. 

I haven't done anything towards improving my sleep hygiene, and I'm still struggling to get out of bed in the morning, and by extension, this is impacting how much time I get on the bike. Plus, we've had a few cool evenings, which makes it great sleeping weather, so once I finally DO drop off, the last thing I want to do is get out of bed.

This weekend, I didn't bother getting on the bike at all, so I absolutely had to make an attempt today, otherwise, I was fearful of backsliding completely. 

I'm keeping up with all my supplementation and self-care.  

Physical therapy tomorrow, and chiropractic on Thursday. Beyond this, nothing new to report.

*Note: Physical therapy never happened. This therapist became increasingly more difficult to schedule appointments with. His unavailability was part of a greater cascade of events which have actually added to my pain, anxiety, and depression issues.

Kaizen: Day 111

Got up at 6 a.m. 

I knocked out 30 minutes on the bike, packed my lunch, and managed to make a batch of Beef Burgundy in my pressure cooker, before showering up and heading out for an 8 a.m. orthopedic appointment which was booked spontaneously yesterday.

Not to belabor the point, but I'm in a LOT of pain. The NP has been going through the motions to file an appeal with the insurance company to approve the hyaluronic gel injections for my knee. This has been going on since May, as I was hoping to get the shots on schedule in June. And here it is, June is almost over and no shots. 

I called the NP to follow up on a voicemail she left me, and mentioned how much pain I am in, and can I get a cortisone shot in the interim while we wait for the insurance appeal process to conclude.

I got the shot in the knee, plus an Rx for more PT, plus an Rx for meloxicam. 

On my to do list today, I need to update my supplement list, and email that PLUS my full radiology packet to the NP.

Perhaps some TEMPORARY relief is in sight.

PERHAPS.

While I am philosophically opposed to cortisone, for what I feel are justifiable reasons, at this point, I'd snort Draino if someone said it would help. I view the cortisone as = to Draino at this point. 

Doing nothing, as always, is not an option for me. Even sitting still, appearing inert, I am always thinking.

The only card I can play right now is to do whatever is necessary to keep walking, and at the moment, the cortisone + meloxicam is the only option for me (well, the only option, in addition to my regimen of chiropractic adjustments, acupuncture, and physical therapy). 

Look how dismissive I am about "the only card."  On the surface, I'm so dismissive as if I only had one of a kind; but the reality is, I have either four of a kind, or possibly 1 card shy of a full house. (I need to get better about my playing card analogies.)

All The News That's Fit To Blog

Oh crap. I thought I had enough stamina and give a fuck to sit here and peck out an update regarding Monday's trinity of appointments. I guess I'll have to do a quick and dirty.

Appt #1: Rheumatologist. Clear bill of health. No auto-immune inflammatory diseases causing my pain. NEWEST DIAGNOSIS: enthesitis. On an upnote, my blood pressure was 110/64, so apparently, the combination of riding my bike 30 minutes each day, PLUS tinkering with my magnesium formulation (I transitioned from magnesium oxide which I was on for years, to magnesium glycinate, and in the last 3 weeks I transitioned to magnesium taurate). My bp was trending lower when I got my bp checked before acupuncture appointments, but this was my lowest reading yet.

Appt #2: Orthopedic surgeon. I went for a consult to see if I could get surgery on my knee. Turns out, despite the degeneration and oseophytes in the knee, I'm not "there yet," and the result of the physical exam was that the bulk of my pain isn't from the degeneration in the knee, but is soft tissue realted. Second diagnosis of the day: enthesitis.

Appt #3: Endocrinologist. I decided to err on the side of being conservative and seek out an endocrinologist. It was 14 long years of going 3-4 times a year to my former endo, and I was hoping I could get away without an endo. Initially I thought my GP could handle things, and then I got it in my head that a possible mover-and-shaker for the pain might be hypothyroid. The appointment was informative and uplifting, and I don't have to go back for another year.

So while yes, the results were good and positive: Yes, my blood pressure is the lowest it's been since I was in my early 20s; and NO, I don't have RA, Psoriatic Arthritis, Fibro, etc; and NO I don't need surgery yet--getting a diagnosis of enthesitis doesn't really help me. I already knew or sensed what this IS (pretty much it's a systemic tendonitis and inflammation of the enthesis, the point where tendons attach to the bone--and possible arthritis related to this too), it doesn't help me eliminate or even minimize my pain.

Hell, even my theory of it being pseudogout was a nonstarter--as my TSH report from the endocrinologist came back well within normal parameters. 

The day was beautiful, and appt 1 and appt 3 were both at the same location, with the ortho blowing a hole through my day by not being able to move that appointment later in the afternoon. 

Appt #1 and Appt #3 were at E85th, and Appt #2 was at E38th. And well, once Appt #2 was over, I convinced myself to WALK back to E85th. And I did more walking afterwards, and before I knew it, by the time I got home, I realized I overdid things. Here it is, four days later, and I am now walking with my cane. If I have a good day, a good day is as bad as a bad day (or perhaps even WORSE than a bad day), because I end up overdoing things and paying a hefty price for days or weeks after.

Imagine it. Me. In pain. Back, hip, knee, groin, you name it, and I managed to walk this far.

I have no recourse for treatment other than to find YET ANOTHER physiatrist*, start from scratch with them, get more Rx for PT, perhaps get some cortisone shots (yes, plural) and hope that helps get me through the hump. And I've been doing a bit of research regarding buying a cool laser so I can treat myself at home. Pricey! But I am sure it will all even out, if I were to factor in how many appointments I'd need with my chiropractor before I start feeling any relief. 

So, I am now bottoming out, mood-wise, I feel like shit, and I'm walking with my cane, and I'm wondering why it's an ALL OR NOTHING thing with me. Why couldn't I just have stopped walking?

*Note: It took me eight more months until I located my fourth physiatrist, aka P4.0. 

THEN AND NOW

Medications that I used to be on before my gastric bypass:

Riomet/metformin
Actos
Tricor
Effexor
Quinipril
Aldactazide 

Additionally: I was on Xenical and later Topamax, both with the promise of helping me lose weight (and the Topamax was promised to help my migraines), and both medications did NOTHING except make me miserable. I was also promised the metformin would help me lose weight and what a load of horse-shit THAT promise was. I had over 10 years of gastric distress.

After my bypass, how many of those medications am I still on?  TWO: quinipril and aldactazide.

Medications & injections I have tried in the past to help my assortment of pain:

Cymbalta: The promise was it would help w/depression and low back pain; it did nothing except make me gain 10 lbs I have YET to dump off;
Frova: This helped me a lot; and about 3-4 years ago, a neuro-ophthalmologist I was seeing suggested I start taking Vitamin B2 every day, and I stopped taking the Frova entirely; 
Kenalog: I had precisely 1 kenalog injection into a facet joint in my spine and it did nothing;
Cortisone: I had precisely 1 cortisone shot in my elbow and it did nothing;
Synvisc/Euffexa: I went through a year of shots 3 in each knee, 2x last year, and it helped, minimally. 
Topamax: I went on this one more time, this time at the suggestion of my neurologist, who promised me it would help with my chronic pain in my low back--it did nothing for the pain.
Tramadol: I had an Rx for this for the longest time, and to be honest, it didn't do all that much except make my head fuzzy.
Flexeril: It worked in so far as it helped me relax enough to go to sleep. 

Pain medications I am on to this day: ZERO.

Treatments I have had in the past for my pain:

Physical therapy--though it was all exercise, no hands-on fascia work
Kenalog injection
Diflucan patch
Diflucan gel
More physical therapy
Occupational therapy with a hand specialist for my unrelenting elbow pain
Chiropractic
Deep tissue massages
Trigger point injections with massages after
Synvisc/Euffexa injections
High volume saline injection under IT band
Cortisone injections in bursa in elbow and hip
Ultrasound
Cool Laser
TENS/EMS

Of those treatments, which ones do I continue to this day: ZERO.

Current pain management plan:

Chiropractic
Physical therapy w/myofascial work & traction
Acupuncture
Deep tissue massages 

I would like to buy a professional grade cool laser for home use. And I am actively looking into getting my right knee replaced.

Speculating on Cascade Effect

I cannot help but wonder if my gastric bypass which I had in 2011 is to blame for so many of the problems I am having:

• Thyroid nodules (Possible new diagnosis I anticipate coming: Hypothyroidism)*--I don't recall having them (or as many of them) prior to the bypass. Surely, losing weight made detecting the nodules more obvious; however, I wonder if this is the result of the excessive amounts of calcium citrate my bariatric surgeon insisted I take daily (2000 mg). I only cut it down to about 800 mg about 3 years ago, so I cannot help but wonder.
• Proteinuria--I don't recall having this big of an issue with protein in my urine like I do now. I vaguely recall "microalbumin" but it wasn't anything my endocrinologist would remark upon. I cannot help but wonder if this is the result of my diet being protein-focused, and I'm considering dropping my daily protein shake (23 gm).
• Hyperuricemia--I don't recall being diagnosed with gout or borderline for gout, prior to my bypass. I know I was being monitored for it, but I don't recall all too many months where my lab reports documented levels in the 6-7 range. Again, too much protein? Or some other root cause? Between the proteinuria and the hyperuricemia, I am TERRIFIED of kidney failure.
• Chondrocalcinosis (Possible new diagnosis I anticipate coming: Pseudogout)*--Last year I had an MRI of my knee and the notes had a remark about chondocalcinosis present. This is above-and-beyond osteoarthritis, and from what I can determine from just a preliminary skim, the chondrocalcinosis is calcium crystals, whereas “gout” is urate crystals.  I have sought out a rheumatologist for a consult, and found a new endocrinologist and hope to get this mystery figured out.
• Post-Prandial (aka "Reactive") Hypoglycemia--It seems in my zeal (and terror) to reverse my risk factors for Type II Diabetes, I have traded it off for post-prandial hypoglycemia. I am not on medication for this, and manage it by eating multiple smaller meals throughout the day, and avoiding excessive consumption of refined carbohydrates. Even things like fried chicken could be enough to make my glucose dip a bit. I do love crunchy pretzel thin crackers (not more than 1-2 oz), but you gotta live a little--right? Mama needs flavor and texture.
• Enthesitis*

*I have noted these three with an asterisk as they could very well be linked or otherwise inter-related. I have my suspicions of the hypothyroid, as I've got a lot of symptoms that could be related to hypothyroid (which could have been dismissed as symptoms of my PCOS). 

Also, it'd be nice *IF* hypothyroid *IS* the culprit rather than pseudogout or RA, or Psoriatic Arthritis. Given the choices of medications, I'd say Synthroid is the lesser of the evils (evils being things like methotrexate, Colchicine/Allpurinol, and other medications that carry with it more unpleasant side effects).

I have highlighted in red the hypothyroid symptoms which I currently am experiencing:

• Fatigue
• Increased sensitivity to cold (more pronounced after my gastric bypass)
• Constipation (more pronounced after my gastric bypass)
• Dry skin
• Weight gain & inability to lose weight (See also: PCOS symptom)
• Puffy face
• Hoarseness
• Muscle weakness
• Elevated blood cholesterol level
• Muscle aches, tenderness and stiffness
• Pain, stiffness or swelling in your joints
• Heavier than normal or irregular menstrual periods (See also: PCOS symptom)
• Thinning hair (See also: PCOS symptom)
• Slowed heart rate
• Depression
• Impaired memory

In the interim, between seeing my rheumatologist on 5/23/18 and when I see him again for a follow up on 6/18/18, I have held off on taking my resveratrol and cherry extract, and I have cut my alpha lipoic acid in half. 

The alpha lipoic acid and the resveratrol might be impacting the conversion of T3 to T4 (and I don't know enough about what testing that was done in the past to know to what level or generation my thyroid function was being tested). But I figure it was worthwhile holding off on these particular supplements until I see the rheumatologist and the endocrinologist on 6/18/18.

Additionally, I am holding off on taking my cherry extract, as I am suspecting that there could be a possibility I was over-doing my anti-oxidants and perhaps my constant pain/discomfort might be the result of a pro-inflammatory effect. I figure a month without these supplements might be enough to see if my theory proves true. I just worry about the impact of going without will have on both, my cholesterol levels and my uric acid levels.

Kaizen Day 83 & An Update

Still at it with the bike, though I had physical therapy on Saturday and gave myself Sunday to rest, and back at it yesterday. Today I had to go to the dentist first thing in the a.m., so I had to blow it off--and I might try to get on the bike tonight--but I have a chiro appointment. 

Other developments:

5/23 I had a consultation with a rhematologist to get screened for things like RA or Psoriatic Arthritis, etc. I gave him enough information to support CPDD/CPPD (aka pseudogout), too. And given I am convinced I might be sub-clinical for hypothyroid--the pseudogout dovetails nicely with that. I also saw my kidney doc for my usual six month follow up visit. 

Bad news: I am up 5lbs (and I don't mean the 5-7 lb "vacillation" I have been struggling with, but 5 MORE pounds on top of that), so I'm up 10-12 lbs over where I want to be.

Good news: I think I may have tinkered my supplements enough where my diastolic bp has been trending towards a consistent /70 for the last 2 months. 

I also suspect the combination of anti-oxidants I have been on is too much, and maybe SOME of the pain I am experiencing might be a pro-inflammatory response, so I'm dialing things back a bit and waiting and seeing if it has an impact.

6/18 I have three appointments scheduled. First up will be the follow-up visit with the rheumatologist. 2nd appt of the day will be a consultation with the ortho who replaced my kidney doc's knee. 3rd appt will be my first appt with who I hope to be my new endocrinologist. Lots going on that day. 

Struggling to move, stay motivated, and trying not to let my anxiety and depression get the better of me. I don't have time to hold anyone else's hand/s these days, and even less patience to put up with some folks who are so self-unaware to realize they've been shitty disappointing friends. I get it, I've got a lot of issues, and I'm working towards changing that, but if I've said "I'm so depressed at the idea of a possible fibromyalgia diagnosis" and you, yourself have fibro, and you do not reply to that text on your phone (yet the day before, your text to me would rival War and Peace in length--and yet you claim you did respond--yet none was received on my end), I have nothing more to give. And this is the nicest way I could put this. I'm not going to get into it further. 

Kaizen: Day 50 (PS)

As I mentioned in my previous post, my biking has improved my stamina, but not much else that I can see on the surface. I had high hopes it would help my daily pain issues. But progress is taking different forms in revealing itself. First, improved stamina. And second, apparently, it's shaved about 18 points off my systolic blood pressure. My norm hovers around 138/80 or 140/90, and my bp for the last two readings at the doctor have been 120/80. Now IF ONLY I can get that pesky 80 down to a 70, I'd be satisfied.

Kaizen: Day 50

Struggling with depression and pain (STILL, I know), and thought I'd give myself today to sleep in a bit (45 extra minutes) and blow off the bike.

I got up at 7:30, and when I realized Maharajah was working from home today, I realized that I could manage my 30 minutes on the bike before getting myself ready for work. 

I cannot tell, does this mean it is now an ingrained behavior and habit?

I convinced myself I need it at least for helping with my circulation. And I knocked it out, no problem. 

But I'm still fucking depressed and despairing, and an upcoming vacation isn't enough to turn that around (newsflash: it NEVER is enough to turn things around). The sun and change of scenery will be nice, but right now it's too abstract for me to process or even anticipate.

No call or email from surgeon at NYU Langone yet. And I checked my email (the one I use for such purposes), and it's devoid of any replies regarding the resumes I sent out earlier this week.

During my session with my therapist yesterday, he and I both agreed that all things considered, I am "managing well" in spite of the setback of not getting the job, and no real resolution to the pain issues.

27 More days until I have the day of EPIC APPOINTMENTS (rheumatology consult, my nephrology check up, and the endocrinology consult). Was hoping to round things out with a consult with the surgeon.

Hurry up and wait.

Kaizen: Day 48

I have been maintaining 30 minutes on the bike every morning for several weeks (almost a full month now), and I am contemplating concluding each work day with another 30 minutes. Maybe that will happen at some point this week, I don't know. 

I'm more than a bit ambivalent with a lot of things right about now, primarily due to me daring to HOPE that the job interview would have led to a job. They let me sit and stew for four weeks and let me know this past Friday that I didn't get the job. Yesterday was yet another indication of how shitty this place is, and how I desperately need to get the fuck out of here, and yet, me and my shitty knees and pain problems intimidates me into thinking I cannot manage the subway stairs every day.

I was in Manhattan on Saturday, escorting the daughter and son-in-law of a dear friend around town. We went from Times Square where their hotel is, took the shuttle to Grand Central, then the 6 down to Little India, where we had lunch and did a bit of shopping, then Uber'd it down to China town and Little Italy for another knosh and coffee and pastries and Malaysian beef jerky shopping, and before I knew it, I had amassed 11,210 foot steps. I was going to share the screen cap of the fitness thingy from my phone, but I can't upload images to the blog ATM.

So while I have felt all along that the biking was not helping me in my day to day pains, apparently it has helped me in other ways, namely my ability to walk A LOT, and the next day was just like any other day for me. This is not to say I was pain free; however, I wasn't crippled up with ADDITIONAL pain, meaning MORE pain on top of my status quo baseline of pain.

I called NYU Langone this week to find out about scheduling a consultation with the surgeon who performed the knee surgery on my nephrologist. I sent them my imaging bundle of my lower extremities, and I should know, hopefully, by tomorrow if I can have a consult with that surgeon or if he will refer me to an associate. And while on the surface it might not seem like my knee problems are extreme enough to warrant a knee replacement RIGHT NOW, I am having horrible difficulties climbing the scant 15 stairs to get into my house, and couple that up with the IT band syndrome and the trochanteric bursitis in my hip (all on the right side), I am finding I am able to do less and less, and I fear that it will continue to self-perpetuate. 

Additionally, I am convinced the collection of pain issues is limiting my mobility and the things I choose to do, and is most likely the reason why I am unable to lose more weight, as well as having difficulties maintaining whatever I've lost as well.

Kaizen: Day 30

I think I am close to convincing myself that I have actually managed to establish riding my bike as a HABIT. Perhaps a bit more into this, and maybe I'll be confident of it. Leopards can't change their spots, and I am depressed and lazy and would rather do NOTHING, but that's not a choice I want to make.

That all being said, after roughly about a week of sustaining the 30 minute mark, and perhaps it's premature to expect greater things, but whomever said that exercising helps with pain management etc, is full of horse shit. My knees continue to hurt as much as they always ever have, and the tightness with the IT band syndrome, and my low back pain has not changed even in the slightest.

That all said, I'll stay the course, and try to get more consistent with giving myself an additional five minutes after biking for me to elevate my legs to help with blood flow, oxygenation, etc. Also, I am now hoping the biking regularly will help me get in front of the borderline left ventricular hypertrophy, which has me bugging out right about now.

I started the P5P supplement a few days ago, and I will have about a month of use before I see the nephrologist next month. Perhaps it will help? Who knows. I'll formulate some questions for that session, too. 

I got my report back from the thyroid ultrasound and my Pink Unicorn isn't going to send me in for a FNA; however, I think maybe I might end up needing a endocrinologist--but perhaps will set that up next year. Perhaps. I'm done obsessing, and yet at the same time, I want to be proactive. 

Kaizen: Day 28

I'm still chipping away at it. Have consistently done 30 minutes on the bike every day this past week, and a few days therein, I made attempts at incorporating an additional 5 minutes where I am elevating my legs after riding my bike, to help with blood flow etc.

This morning, I got absorbed in replying to a lengthy email, and rather than do 30 minutes, I ended up doing 53 minutes. I don't know if this will be a daily thing, or if I'll eventually work up to 45 minutes consistently, but 53 minutes happened today. Plus, I elevated my legs (and didn't have my timer on hand, so I counted to 100 as I elevated my legs).

Now, regarding doing Kaizen for my sleep hygiene--I haven't gotten control of that yet. I've been sleeping in my spare room, so as to have uninterrupted sleep, whenever I finally do manage to drag myself to bed. And at least once this week, I sprayed some "magnesium oil" on my knees and elbows and rubbed it in before bed, as it helps to relax me. 

Still chipping away. And I'm even doing Kaizen progress on other things: My annual organizing/purging of household stuff, as well as refurbishing a pair of sandals to possibly get one more spring/summer's use out of them.

KAIZEN ALL THE THINGS!

Splitting Hairs: Part Deux

Which is worse? 

When you articulate how depressed you are, someone who says they are your friend does this:

1. Tells you to "just get over it"; or
2. Ghosts you/says nothing at all.

Just curious.

Kaizen: Day 22 (30 Minutes!)

Last night, I failed at getting to bed around 11. Instead, I stayed up, such as it was, nodding off in front of the t.v. until close to 1 a.m., and then toddled off to bed. At least I went to bed in the spare room, so at least I'd have an uninterrupted sleep experience. Tonight I'll do better. The Murphy bed is already down, so it's a matter of setting a timer, and doing certain things to prepare me for bed. Perhaps I'll crochet a bit to relax. It's been a while since I've hooked.

This morning, Maharajah decided to work from home, so that changes my morning routine and gives me more time for me and my Kaizen experiment. I managed to not only ride the recumbent bike for THIRTY MINUTES, but I also gave myself an additional five minutes, and elevated my legs to help with blood flow (and get some fresh blood back in my legs when I stand back up.

I've also decided to make a few tweaks to my daily dietary supplement line up, too. I've ordered up some (30 mg) zinc glycinate gel caps, and some "P5P" pyridoxal-5-phosphate to take instead of my pyroxidine caps--P5P is a more bio-available form of vitamin B6, and I am hoping it will help me with this pesky proteinuria situation. And since that capsule has about 100 mg of magnesium in them (and I plan on taking 2 a day), I'm going to discontinue taking a separate 400 mg magnesium capsule--and I hope that lowering the magnesium will also make an impact. The supplements arrive by 3/31, and it will give me close to two months of dosing before I see my kidney guy for my 6 month check up. 

I am hoping with these supplement tweaks, as well as the Quercetin I started taking a while back, will be just the thing to disturb and change the uric acid & proteinuria problem. My numbers in my blood tests might be "holding steady," as my kidney guy says, but given the "borderline left ventricular hypertrophy" on that TTE from last week, I am now back to being terrorized/traumatized by the idea that no matter how vigilant or compliant I am, there's only so much I can do and my body and family's health legacy will fight me every fucking step of the way.

My body continues to be a cantankerous asshole, and I am still not on speaking terms with it. 

Kaizen: Day 21

Last night was PT, so I did my usual 10 minutes on the "stepper."

This morning it was a bit tight for time, but I managed 15 minutes on my bike.

I had my usual bi-weekly session with my therapist today and I ran him through everything for the last week: Colonoscopy, TTE, Job Interview, Snow Storm, slip sliding into the abyss, bringing us to today.

By the time I speak with my therapist again in two weeks, I should know something about the job interview. And already I'm thinking of possible questions to ask and demands to make, if their response is YES WE WANT TO HIRE YOU. If they don't want to hire me, things are much more straightforward: I will stay the course, get my knee replaced, and resume my job hunt after recovery. 

In the interim, I am going to try to focus on the two things I want to change:

1. Continue chipping away at trying to get more active (i.e. using my bike) every day; and
2. Try to get into a decent sleep hygeine habit to improve my sleep.

My therapist quipped that if/when I find the "magic" to make the sleep happen, let him know. My riposte was that perhaps we both should be accountable to each other and work on this together.

Right now, I'm reading up on sleep hygiene, and I'm going to come up with a formula that might work with my personality, habits, household, etc, and get myself on a schedule. 

Kaizen: Day 20

I was tooling along nicely, I thought, for a while, up until Monday, the 19th--and things kind of fell apart last week.

Monday the 19th, I endured both, a colonoscopy, and a trans thoracic echocardiogram.

Tuesday, while still feeling illish from Monday's festivities, I went for a job interview. And the physicality involved in taking the train and subway AND STAIRS (not to mention the stress of LIKE ME, PLEASE LIKE ME, that interviews invoke), I was fried.

Wednesday brought with it, yet one MORE snow storm (Hey! It's SUPPOSED to be Spring!).

Thursday and Friday were more of the same lack of Kaizen. No physical therapy on Saturday. And Sunday, at least provided about 3,000 footsteps.

Monday (yesterday), still no bike time. 

Today, Tuesday, I'll be at physical therapy tonight (this was the appointment that was supposed to be on Saturday).

So the Wednesday that was highlighted, I highlighted for a reason. Early in the morning, I was showering up and getting ready to go to work (despite the snow). And my therapist called, thinking it was a regular appointment; however, we spoke the week before and we weren't due for another session until THIS WEEK. 

We got off the phone once he realized his mistake; however, it's odd how the remainder of my week played out, physical stress from the colonoscopy (the prep was tough, but good that they evicted Pepito my Polyp, and he turned out to be benign), and from the trans thoracic echocardiogram I am "borderline" for left ventricular hypertrophy--the knowledge of THIS stresses me out and I hope to have a conversation with my kidney guy regarding seeing if we can get a little more aggressive with my medications to get in front of this before it turns into a THING.   Then there's the emotional stress that the interview brought on, and a lot of negative self-speak going on, and I'm wondering if I even WANT that job now if they even make an offer. Turns out, as the week went on, I really needed to talk to him. So I have to hold my water, so to speak, until tomorrow morning. 

And regarding the job interview? I should hear something in about 2 more weeks. 

My own game plan regarding my health and Kaizen is the same, and tonight I get a pass as I"m going to the physical therapist tonight and will be on the cross trainer there. So, I need to hydrate more, keep moving, keep trying the Kaizen until getting on my bike is a habit, and maybe elevate my legs at the end of the day. I WAS contemplating tweaking my supplements one more time and perhaps taking more magnesium--but I need to read more about it, and once I am convinced I won't be negatively impacting my kidneys, I'll act. I started reading up on magnesium and it looks like it could help so much regarding the LVH, as well as my on going proteinuria and uric acid issues, but if it is too much for my kidneys to handle, I need to be very conservative, as I'm currently on 400 mg daily anyway.

 

Kaizen: Day 11

Progress is being made, incrementally, as is my plan.

Where we left off LAST Friday, I did 10 minutes in the morning and blew off my evening Kaizen bike session. The last week has gone thusly:

Saturday:
10 min on bike at Physical Therapy

Sunday: No bike as I went out with my sister.

Monday:
10 min in morning
No bike in evening

Tuesday: No bike 

Wednesday:
7 min on bike in morning (short on time, therapy session in morning before work)

Thursday:
10 min on bike in morning
No bike in evening

Friday: 
15 min on bike in morning

Saturday: 
10 min on bike at Physical Therapy
No bike in evening

Sunday (Today):
30 min on bike in morning

The goal here is twofold: 1. The exercise of course, and; 2. making the exercise a HABIT. I remain unconvinced that I am at the "habit" stage of this process as I still have that internal struggle with myself to just set a few moments of my day aside to work on this. Afterall, HOW MUCH TIME do I waste on any given day?  PLENTY, and rarely is that time devoted directly towards improving my health?

Today I will probably be either spending the day either curled up in a ball (unlikely, though part of my brain wants that) or doing a lot of puttering to distract myself from colonoscopy prep today. I ate breakfast, and now it's 24 hours from the time I have to show up for the colonoscopy. And I'm not necessarily well-prepared for day's activity (subtext: COLON BLOW) beyond getting the Rx laxative solution. And even though I DO have a print out of instructions from the gastroenterologist, I still found the wording vague, and perhaps they should condense it all on one page and give you a 24 hour timeline. Just a thought. I'm already starting to get a stress headache around my ears ALREADY, just at the thought of everything. But the sun is shining and looks like it'll be a good day, albeit weather-wise.

I am scheduled out of the office tomorrow, with a 9:30 report time for the colonoscopy, and a 1 p.m. TTE (trans thoracic echocardiogram) scheduled for 1 p.m. And laundry pick up will happen therabouts, and lunch, and it looks like a full day.

Tuesday I may/may not call out sick, as I have one appointment tentatively set, and once I get the time and location, I will then call another recruiter who called about another job (same company) and see if I can push along/coerce/convince them to try to book the second interview the same day. If I am going to have an anxiety attack about taking a sick day the day after a scheduled absence, I might as well make exceptional use of my time.

Unlike the Kaizen bike bit, which is all MY INFLUENCE, this Kaizen regarding chipping away at finding myself another job is pretty much entirely out of my control; however, I am grateful that I am getting a lot of interest at least in my resume and phone interviews--the latter of which I can hide behind the phone and hide my Bitchy Resting Face, which can be intimidating or perhaps convey messages I don't want to convey during a job interview.

But that is something for me to worry about for Tuesday. Today I can only live in the moment, even if that means I'll be living in my bathroom for the better part of this evening.  Ugh. 

Splitting Hairs

Which is worse? Someone who knows they are ghosting another, or someone who is unaware that their actions make it appear as if they are in fact, ghosting another?

Just curious. And no. I won't be replying to any comments (if any are in fact, left).

Daily Kaizen: Day #5

THURSDAY
Morning: 5 min
Evening: 5 min

FRIDAY:
Morning: 5 min
Evening: 0

SATURDAY:
Physical therapy appt: 10 min

SUNDAY:
Morning: 0
Evening: 0

MONDAY (Today)
Morning: 10 min

SUPPLEMENT TWEAKS:

Discontinued digestive enzymes I resumed in January after my trip. Blood glucose was running a bit high. Decided to reincorporate CLA into my daily mix of supplements. 

Yet another article regarding Kaizen. 

So, if I were to LITERALLY make 1% improvement daily, and a day = 86400 seconds, I'd have to dedicate LITERALLY 1% of my day, 14.4 minutes to work towards that daily improvement.

Thoughts, Words, Deeds, Habits

Your beliefs become your thoughts,
Your thoughts become your words,
Your words become your actions,
Your actions become your habits,
Your habits become your values,
Your values become your destiny.

― Mahatma Gandhi 

I've been on the fence for TOO LONG (YEARS in fact!) when it comes to exercise. Being in constant pain from an assortment of issues does not help. More activity = more pain. And that is where the entire THOUGHT of exercise begins and ends. It hurts too much. And if that weren't enough, I detest sweating.

I'll be 50 in August, so there's only so much longer (which is to say NOT AT ALL!) I can continue to blame my parents and the poor examples they've set for me about how to "adult." But what to do? 

Currently I've been going for acupuncture, in addition to my regular chiropractic and physical therapy and massage appointments. I decided today to get back on my protein shakes in the morning (instead of waiting for the afternoon--and some days I forget or decide not to have my shake). And UGH, I need to try to hydrate myself more sufficiently, as this no doubt is impacting a lot of things from my blood work being skewed a bit, or my kidneys not flushing out the things it should flush out.

Let it be known: This morning, I decided to have a different approach to exercise, or at least in the ESTABLISHING of a HABIT of exercise. 

I've decided to emulate Kimmy Schmidt with her 10 seconds at a time approach to pain or difficulty:

I've actually used that philosophy at times, give myself a moment, breathe, and ten seconds later, lather-rinse-repeat if necessary. 

Somewhere along the way, I saved an article about Kaizen (the definition of which is "slow, continuous improvement," and I even found some other articles (i.e.) devoted to applying Kaizen in small increments of time, to work towards fulfilling goals. I might not know much about the process, but at its core is making small, manageable changes or sustainable progress towards a goal. 

I have a very short list of what I want to work on in my life: 

1. Exercise more.
2. Find a new job.

Both of these two goals involve tedious work, but if I just "keep at it," chipping away at it daily/weekly, eventually I'll meet my goals. 

In the case of the exercise, I just associate so much unpleasantness along with it, but the reality is, the more I put it off, the less active I am, and the less active I am, the more problems I will have to deal with later as a result. So it's imperative I work at it NOW.

So, this morning, while my coffee was brewing, I hopped on my recumbent bike for five minutes. Five minutes seems a laughable duration. Rome wasn't built in a day. And I know if I push myself by a longer duration or by increasing the resistance on the bike, I know I'll hurt more tonight or tomorrow, and thereby make it more likely I won't get on the bike again any time soon. 

(Full disclaimer: After five minutes on the bike, I also did some stretching with my resistance band and  about 10 pumps on my Thigh Master. Baby steppin'!)

(God I hated "What About Bob," but the one thing they got RIGHT in that flick was the simple idea of baby steps.)


Tonight, I hope to repeat this action, hop on the bike, and ride for 5 minutes. Heck, I might end up riding longer, as I think that watching a TEDTalk while riding my bike, might make the time go quicker, and in the process, I'll be pumping some useful information into my brain.  I enjoy TEDTalks, so perhaps I can end up looking forward to my "5 minutes here, 5 minutes there" routine and sustain it for a while, and hopefully it will become second nature to me and I won't view it as such a chore. PERHAPS. It's a theory at least. Perhaps I can start and end my day with a TEDTalk and bike routine. Let's see how I do tonight with watching the TEDTalk while I bike--I didn't think of "baiting the hook" with a nice reward for WHILE biking. I just thought of this idea just now.

I'm thinking it, and speaking it, and hopefully my words become actions, and my actions become HABIT.  The more active I become now, hopefully will equate to a quicker recovery time when I finally get my knee replacement (later this year). 

My overall objective is to make my NEXT 50 years be the BEST years. Let's just see how tonight goes.

First Post of the New Year (and February is almost over)

So where we left off--Thanksgiving was a hit, always is, and in the end I'm glad I do it. The end of the old and beginning of the new year brought with it a phenomenal trip to Asia, and despite gastroenteritis and being stoned on scopalomine, and having my joints GROUND AWAY by all the walking and stairs, it was an amazing, amazing trip.  

I got back in the office on January 11th, and I decided to try and find my pink unicorn I have been looking for, forever: a DO (doctor of osteopathy) who is an internist (vs one who is in sports medicine). And my glorious pink unicorn is three blocks from my office, and she takes my insurance. I set up an appointment for the following week to establish myself as a new patient.

The first visit went well, and I arrived well prepared to have an actual discussion on things I wish to accomplish this year: get an ortho consult to see if I can start the process to replace my knees, get a gastro consult to see if we can find out the cause of the RLQ pain I have endured 5 out of the 7 years since my bypass, and the last issue is whether or not I need to get a new endocrinologist, or can she monitor my bloods and send me out for thyroid ultrasounds, to monitor my nodules in my neck.

The first visit, she knocked everything out of the park on one go. I got my referrals for the ortho and gastro, and she said she could handle monitoring my nodules. And before we concluded the visit she asked if there was anything else I needed. I said how I thought I saw on their site that they had an acupuncturist in their office, and she responded in the affirmative, and I promptly scheduled my first acupuncture visit for the following week. 

The next week came the ortho consultation. And right now, they are not in a rush to get my knees replaced, and there was mention that if I DID get my knees replaced, perhaps a partial (where they replace the knee cap) would be better for my situation. My physical therapist suggests no, due to my pain being all on the outside of the knees. Follow up on 2/28 w/the NP at the ortho's office for a Rx for more PT, and give it one more month until another discussion and assessment.

Along the way, the Maharajah started to get anxious about this mole on his shoulder, and said how he said it felt like it has "changed," which immediately gets me anxious, and we scheduled time for him to get in to see the doctor--I thought she'd give him a referral to a dermatologist--but no! She was able to figure everything out for him in one go. She assured him the mole was a keratosis, nothing to worry about. She had him provide a stool sample because he was having problems with his gut since our trip, and while he was there, she gave him a flu shot. Yet another HOME RUN my "Pink Unicorn" knocked right out of the park, again!

Last week was the gastro consultation. And I knew I was in the right place, as he made very quick work with figuring out what my pain is, as neither my bariatric surgeon, nor my former PCP (who is a gastroenterologist!) were able to figure this out, especially given when they do their examinations, they NEVER ONCE removed my surgical gown to see that the very site of my pain (and it's deep in the meat/fascia) is directly beneath a puncture/incision site for my bypass. 

Turns out whatever pain I have been experiencing is not something wrong with my cecum or appendix, but is NEUROLOGICAL pain, as the nerve that is right there must have been nicked during the surgery. The pain comes and goes and isn't a persistent-every-moment-of-every-day type of pain, and yep, YOU GUESSED IT, there is nothing they can do for it. But at least I know it's nothing more serious than a damaged nerve. That aside, we have scheduled an appointment for a colonoscopy (FINALLY!) to take place in about two weeks. 

The only little red flag that has popped up so far is, I scheduled a day off to accommodate what should have been my annual check up (fasting included) as well as the gastro consult--and Pink Unicorn had to reschedule. The rescheduled appt is this week sometime, so let's see if she is able to keep that appointment, or if I'm going to have to rethink things. As it stands, it's pretty inconvenient to go to the Pink Unicorn, as the office does not have evening or Saturday hours, and I have to schedule time from the office to BE THERE. 

To have appointments rescheduled can really mess me up--and given that the appointment I originally had was a 9 a.m., with the gastro guy being at 2, Pink Unicorn pretty much blew a hole through my morning. So, only time will tell if it was a "one off" type of thing (that happens to everyone, from time to time), or if it will be a thing that defines her character.  Hurry up and wait.

And not to be outdone, I've been pretty pleased with the MD who does the acupuncture. I've seen her 2x thus far (with a third time to be on the same day my annual physical takes place with the Pink Unicorn), and I find it hasn't helped much overall, but it has helped the bursitis in my right hip a smidge. 

My medical insurance will cover acupuncture for up to 12 visits, so I'll ride this out until the end of March, by which point in time, it should be about 5-6 visits into this relationship. During the first visit, while I am prone on the table with needles sticking out of me like a porcupine, she asks, "Have you been screened for fibromyalgia?" And I have to admit, that NO, I haven't, and it would upset me immensely if I get that as a diagnosis.

And the last thing to be addressed on my "list of three" which I presented the Pink Unicorn in my first visit, will be getting my thyroid monitored. She'll run a thyroid panel with my CBC and Chem7, and hopefully I'll walk out of that office with a Rx/scrip to get the sonogram done. 

Once March is over, I can coast until almost the end of May when I see my kidney guy again for a routine visit (I go every six months), and I have scheduled a consultation with a rheumatologist at that same practice (to keep all the information in one place, and hopefully whatever the rheumatologist thinks will complement or enhance what the nephrologist thinks. I'm already being monitored for gout/pre-gout, and given that one of my MRIs had some notation of CPPD or chondrocalcinosis, the possibilities are endless right now about what might be causing my pain: gout, pseudo-gout, pseudo-RA, pseudo-polymyalgia-rheumatica. And depending on how the rheumatology consult goes, I hopefully can coast on through until December without seeing another doctor.

*ETA 2/12/19: Pink Unicorn or no, scheduling is a huge issue for me, and I'm at the point in my life where I shouldn't have to work hard at scheduling appointments around a very limited office schedule--Pink Unicorn doesn't have evening or Saturday hours, so it's a challenge to schedule to get in to see her around MY work schedule. Pink Unicorn or no, I'll need to find an internist who actually will play nice with MY schedule.