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.

A Glimmer

Good news: No changes on my thyroid sonogram--so that means no need for a biopsy! I just wish that I could have had a repeat of last year where one of my nodules just up and disappeared! We can't have it all, I guess.

Physician Fatigue: Part 4(a): LESS Insanity

I decided to go to an imaging center close to home for my thyroid sono--and by close to home, I timed it, and it's about 7 minutes, door to door if I catch all the traffic lights.

There was a bit of maneuvering to schedule the sonogram, as the sono is done in one place, and if need be, the biopsy will be done (I believe) at Westchester Medical Center, five minutes from my home; however, once the maneuvering (i.e. getting a new Rx for the sono, and a separate one for the biopsy) was done, the entire process was a breeze. I just wish I hadn't gone through the drama with Janice at Mt. Sinai Radiology Associates immediately before attempting to schedule this appointment, because THAT entire mess truly did frazzle me, and made me edgy so the instant there appeared to be a hindrance,  I got agitated. 

Lucky for me, the professionals at Advanced Imaging very quickly resolved everything and the appointment was in place. I called on or about 3/22, and managed to get an appointment for 3/29--easy, fucking, peasy.  

Additionally, from the moment I finished filling out the necessary forms, it was roughly/less than five minutes until my name was called. 

The sonogram took less than a half hour, and I was back home within an hour of when I left, thereby not necessitating me taking a sick day off, or driving myself insane by taking a full sick day to go into NYC for the imaging, and then try to jam 1-2 other appointments in the day to maximize being out of the office. 

Currently, I am basking in the righteous afterglow of using my time efficiently, enjoying the fruit of my labors of trying to streamline all of the running around I must do for medical appointments.  It also bears mentioning that it was a DELIGHT to be treated professionally, and not only that, with more than a smidge of respect for my time. A five minute wait time? Truly I shouldn't be as overwhelmed with happiness as I am, but I AM, and I am appreciative of it.  

My endo should be getting the report sometime tomorrow, and I'll know more then (whether I need a biopsy or not). 

Physician Fatigue, Part 3

Last week, I contacted my (regular) neurologist to forward my records to the neuro-ophthamologist I am scheduled to see in June; and today I will type up a letter to my (soon-to-be-former) neuro-ophthamologist to forward his records, too, thereby consolidating two doctors into one specialist-- who can tend to my optic nerve drusen as well as my migraines (though, TBH, my migraines have abated CONSIDERABLY in the last year).

The hospital system where the majority of my doctors & specialists are is fantastic and has ruined me for medical care in "The 'Burbs." Everything about my experience there is top notch--save for the way the radiology department is run. 

The radiologist is fine, that's not the problem. And he's highly recommended by my endo--and that's why I'm going to this guy. However, the person with whom I must coordinate my appointments OUTRIGHT is inept, and the receptionist in the waiting area just is lacking in every way imaginable--and between the two of these fools, I wait anywhere from 1-2 hours EVERY YEAR when I go for this sonogram/FNA.  

Thursday of last week, I called to arrange the sonogram and FNA. I left a voicemail at 12:30 that clearly stated, "please call me at (work #, provided) AFTER 2 p.m."  This idiot calls my endocrinologist's office back saying she couldn't call me when I wanted--she couldn't call me AT 2 p.m. WTF! 

So I called AGAIN, stating "Please call me at (work #, provided) as I want to schedule my sono and FNA for either 3/22 or 3/29."  The idiot calls my HOUSE PHONE and leaves a voicemail so incongruous I couldn't figure out wtf was going on. Clearly, this person cannot follow simple directions--and I don't care that she appends her outgoing voicemail message with "God Bless," the woman is inept.

So, Monday, I called YET AGAIN, and lo-and-behold, I got her on the phone. She informed me the doctor won't be back in the office until 3/8, and she won't know until that day, WHEN I'll be able to get my appointment with him. So I have set a reminder to call this shit-show of an administrative assistant ONE MORE TIME. It's like the idiot version of being water-boarded, where I'm drowning in the ineptitude of others.

AS IF I weren't already fatigued running hither-and-yon from one specialist to another, I have yet one more interaction with this idiot with which to look forward.

Additionally, It has gotten to the point where I cannot schedule another appointment afterwards, as I have no real guarantee I will be out of there on time to make a second appointment.  I'm now to the point where I am insisting on getting the first appointment of the day--which could be a huge ass-pain to me, as I live 45 minutes north, and if the first appointment of the day is 8 a.m. (let's indulge in a pipe dream, shall we?), and would require me moving heaven and earth to get there at that time.  But if need be, I will. Because waiting 1-2 hours is unacceptable. The entire experience sucks, and curiously enough, THIS PARTICULAR DEPARTMENT is the only department at this hospital which does not send out a survey after my appointment. So I don't even have the prospect of a survey to let off steam and tell people off--I feel very short-changed!

And if this weren't ENOUGH, last week I dropped a FULL bottle of Snapple on my foot, and thought I broke a bone as the last two toes on that foot have been somewhat numb. Today I went to the podiatrist (instead of languishing for HOURS or even a half a day at the ER), and he Xray'd my foot and luckily, no broken bones--but I could have done something else, perhaps more productive, with my lunch hour. Luckily, his office is walking distance from my job.

Protip: If You Work At a Diagnostic Center or Doctor's Office, Take Heed

You might be a moron if:

I schedule both, an abdominal AND a transvaginal ultrasound, and you only manage to schedule the abdominal, which results in me having to get up an hour earlier and make yet another "enjoyable" visit to your facility. Granted the first time I rushed into the facility only to realize I forgot my Rx at home, and you were totally unwilling to assist me (by way of having my husband scan it--yes he was home--and email it to you--and I could have either brought the actual hard copy Rx in later that day OR you could have called my doctor's office and get them to fax the Rx), thus creating a scenario where I have to return to your facility for the abdominal, to realize you ONLY scheduled the abdominal and not both.  So. Okay. The first one? That's on me. I forgot my Rx, but what the fuck? Due to your ineptitude, I now have to fuck up THREE mornings instead of just two. Yes, Hartsdale Imaging, I'm calling you out.

You might be a moron if:
My doctor faxes a Rx for an MRI of a cervical spine, to happen the very evening when I return from vacation out of state--only to rush home to messages, first calling to confirm the appointment, then calling an hour later to reschedule the appointment because the machine is offline.  And of course the appointment is two hours AFTER my scheduled appointment with my physiatrist, of whom I NEEDED THE IMAGES for a proper diagnosis.  So, I arrive at the imaging center the next day, on time, to be asked for my Rx, when my doctor faxed it in FOUR DAYS PRIOR.  Then you call my doc, he tells you to do the MRI and he’ll fax it the next business day (he already faxed it, yet, inexplicably you couldn’t find it). The MRI was supposed to be of cervical spine, yet the CD of the images says “shoulder.” (Images did turn out to be of the cervical spine--so that disaster averted--however, HELLO, how about properly labeling the CD?)  The best of the best? I go to my doctor's office last night, in hopes of relief and hoping to find out what's been causing me severe, acute pain for three weeks--only to find out that you never forwarded the radiology report to my doctor. Yes, Upright Imaging, Yonkers, I'm calling you out. 

You might be a moron if:

At yet another facility entirely (name withheld, as the appointment is still pending, and I bet dollars to doughnuts it will be rescheduled YET AGAIN), my fine needle biopsy was scheduled for 9/25, only to be rescheduled to 9/23 (since they only do FNA on Weds). And 24 hours later, it was rescheduled to 9/30. Oh it also doesn't help matters that your phone demeanor (such as it is), is lacking.

Three separate diagnostic centers or medical offices, three separate fuck ups, with three separate issues still of undetermined  diagnoses due to you just not giving a fuck. Who has time for this shit?

Annus Medicus Horribilis: Best Laid Plans... Blah Blah Blah

I *was* hoping that once summer was over, so too, would be the never ending supply of doctor's appointments and medical wild goose chases. I guess at this point, I'm striving for the end of 2013 being the end of my Annus Medicus Horribilis.

Over a month ago, my internist put me on a calcium channel blocker as an adjunct to my ace inhibitor to hopefully help my unresolved BP issues, to no real avail. The pressure is elevated, but I've been reassured it's not ZOMG STROKE LEVEL!, but still, given the fact I"m already at risk for clots, embolism, stroke etc due to the blood clotting disorder, I really don't want to tempt fate. Also? The horrible headaches which come out of no where, not to be confused with my menses related migraines. I'm losing days of my life to this nonsense.

And as I'll be at my renal guy at "The Mount" next week (and my endocrinologist who is a few blocks away), I was hoping to squeeze in an appt w/a HTN specialist (also at The Mount) on the same day, but the Universe's Power conspired against me and my best intentions to jam as much as I could in that trip into NYC. But perhaps, this is for the best, because after the summer I had, the result of which I never was able to find enough time to do what I wanted to do and go for a class on a particular crochet technique I want to learn. So perhaps if the instructor is available on Columbus Day, and Election Day... perhaps that will take care of two of the three classes (it's a class of three sessions). Perhaps THIS is how it's supposed to be.

So hurry up and wait until Election Day for me to get any real idea of what's cooking with my ticker. No doubt I'll be there having an EKG, ECG and a stress test. No doubt. Fun times await!

As if that weren't enough, last night I started having acute pain in my RLQ (lower right quadrant of my abdomen). I've had this on and off for the last two years. To date, I'm nearing my three year anniversary--well January makes it officially three years, since my WLS, so that's always a worry for me, that somehow I've injured myself.

Last night I ate (over the course of a half hour) a pint of Arctic Zero, a 150 calorie frozen treat, which I view as a frozen protein shake. It's got about 20 gm of FIBER in it, in the form of chicory etc, and perhaps this might TRIGGER the pain, but there's no flatulence, etc. So I don't really know what's going on. And given that I am about 24-36 hours out from the BLOODY DELUGE which is my menses onset, I also think it COULD be an ovarian cyst. Or it could be a kidney stone. Or something with the cecum. 

I emailed my bariatric surgeon's NP regarding this, and I also called and left a message for my internist to call me back with the thinly veiled "RLQ pain." Internist is a GI too, so that helps me. His first impulse was to say I should have my gyno do a sonogram, and well, my gyno is also at The Mount, and that's logistically a nightmare for me to coordinate everything, and I"d rather do as much diagnostic stuff close to home and save my sick days for WHEN I AM SICK BECAUSE I KNOW I WILL BE SICK. I get depressed at this certainty.

Long story short: As I don't have a fever, diarrhea, impactions or any other thing to indicate an emergency, I've scheduled my sonogram for Thursday a.m. before I head into work. 

I hate being this person, and I am wondering when my depression, bitterness and pain just engulfs me entirely.

Benign

Dayenu Redux

I am one more health issue/syndrome away from needing a continuation page for my Medic Alert Bracelet. Yes. I'm dead, fucking serious. Serious enough to wonder if I am hitting that tipping point, and this is the slow slide into the abyss. Truly. That's where my mind is RIGHT. THIS. MOMENT.

And oddly, I'm almost on the brink of laughing. Yes. Seriously. Because I no sooner have intellectualized possibilities of how my biopsy results might pan out [cancer, yes or no?; if yes, papillary or follicular? Thyroidectomy (partial or entire)or nodulectomy?; will I lose my hair? will I lose more of my "me-ness" my sense of self? Accepting that quite possibly surgery and pain (at a minimum) are going to be some short time challenges to overcome], when a well meaning friend drops a conversational dirty bomb in my lap, sight unseen, something that hasn't been discussed, but now has me on hyperalert, worried. 

Hell, the biopsy isn't until tomorrow, with the results available maybe Tuesday or Wednesday of next week, and now I'm worrying about the scenario of "Well, it's not cancer, you've got rheumatoid arthritis."  I had just braced myself for the possibility of cancer, and weighing out the papillary vs the follicular (and not even thinking about lymph node involvement yet for either), and the idea of having RA is just too devastating for me. I dare say, even more devastating than the idea of cancer.

SHORT TERM:
Statistically speaking thyroid cancer (papillary) appears to be what I'll call "manageable." The thyroid is removed, either partly or entirely. Radiation is given. A restricted diet will be part of that "FUN" of the post-op experience while they determine hormonal balances and what not. Mobility of the head/neck will be slowed down/limited. Hormones will be taken daily. Ultimately the survivability of the cancer itself is quite promising, and a good lot of folks go on to live 30-40 years post op without their thyroid. I've read up, prepared myself mentally for a "prepare for the worst, hope for the best" type of thing, then the RA conversational dirty bomb gets dropped in my lap.

My mom's dad had RA and was pretty much debilitated from it (however, at 91 he was STILL more mobile and walked better than my mom does at age 67-68), and HIS dad had RA (and lived to be nearly 100-101 when he died, bed ridden for a good many years of the winter of his life). RA to me might as well be a death sentence. There is no cure. And considering that I cannot take NSAIDs and no doubt a good lot of the RA medications out there (Celebrex comes to mind) would cause ulceration issues for what is left of my stomach pouch after the bypass, the mere thought of rheumatoid arthritis scares the piss out of me. *Amazingly, my mother doesn't have RA, but OA. I'm not sure how she dodged that bullet, considering how many things that are wrong with her health.

LONG TERM:
Rheumatoid arthritis would mean the eventual curtailing and discontinuation of the things that bring joy and meaning to my life: Travel and Crochet. I've come to accept the notion of not having children of my own. Okay. I'm accepting that on a moment by moment basis, and it is still hard (some days harder than others). But to think of the things that bring me joy, traveling the world with my husband, and crocheting, and let's face it, being able to walk of my own steam, unassisted, independent. As it stands, given my mother's assortment of health issues and how her inability to be her own advocate and get treatment at crucial times when it could have made a difference, only to see her handicapped, house bound, and bitter, that's enough for me to be HYPER AWARE and GRATEFUL of every step I am able to take.  The idea of being HOBBLED & wheel chair bound? No travel? No crochet? Perhaps unable to write my own name or type letters on a keyboard? Perhaps unable to grasp a knife to cut a tomato or run a brush thru my own hair?  In the long term, that is not living. It's merely existing and being a prisoner of pain. I just hope that if this were to be my fate, someone would have the good sense to smother me in my sleep once things got so deteriorated I'd need a wheelchair or I can't brush my own teeth. Seriously. 

I have no doubt that the friend who was suggesting a papillary thyroid cancer/RA connection was trying to be helpful but it's about as helpful as someone trying to cheer me up or show support by saying:

"Hey! Maybe it's not cancer, maybe it's LUPUS!"
"Hey! Maybe it's not cancer, maybe it's MS!"
"Hey! Maybe it's not cancer, maybe it's ALS!"

So, it's not bad enough I still have tomorrow's fine needle biopsy to endure. And now I'm even MORE scared shitless than I was before.

It's just too much to process.

In summation (if you're keeping score):

Papillary cancer = lower recurrence rate, but also has the possible bonus WILDCARD of rheumatoid arthritis

Follicular cancer = higher recurrence rate

What The "F"

Friday.
Fourteenth.
Fine needle aspiration (biopsy).

Hurry up and wait 11-12 more days before we know anything conclusively.

Blood Work: A Trajectory

Cortisol is problematic. So far every other test (so every six months) the numbers spike. I suspect it might be White Coat Syndrome given the horrid quality of care/service I get at Quest Diagnostics. I'm tired of complaining to corporate about it, as it doesn't amount to jackshit in the scheme of things, and I've seen zero improvement. And the last time I was there (May), the blood draw was so bad, I had a very painful welt the size of a halved tangerine in the crook of my arm for DAYS.

I have no doubt that the stress I undergo each time I've been to Quest Diagnostics has adversely affected my cortisol levels. The undue wait time, the rushed nature of finding a vein, how harried the single solitary lab staffer is. To under staff a  heavily trafficked site like Quest does is not only a fuck you to those who work there, but also to the clients/patients who rely on this being the most proximal lab for them to go to for their blood test needs. Plus? Most of us are fasting, so yeah, make us all wait LONGER, make us MISERABLE while we're there. Fuck you. I'll take me, myself, and more importantly MY INSURANCE MONEY elsewhere. Labs are a dime a dozen. I think there's one spitting distance away. Sayonara, motherfuckers.
Anyway, where was I? Oh yeah... A trajectory of my blood work results:


5/2/13:
Creatine, Random Urine 91
Protein, Total Urine
Urine Total Protein 769 H Range: 50-240 mg/L
Protein Total, Urine 846 H Range 21-161 mg/g
Creatine: 0.62 Range 0.50-1.10 mg/dL
Bun/Creatinine Ratio Normal Limits
Uric Acid: 5.3 Therapeutic target for gout patients: <6 br="">Albumin 4.2
Cortisol, Total serum  31.0 H (Reference range: Cortisol AM 4.0-22.0 mcg/dL; Cortisol PM 3.0-17.0 mcg/dL
C-Reactive Protein 0.1
Hemoglobin A1C 5.3 (Reference range: <5 br="">

2/20/13:
Creatine:  0.57 (ref: 0.50-1.10 mg/dL)
Bun/Creatine ratio Normal limits
Protein (serum) 6.7 (6.1-8.1 g/dL)
Albumin 4.1 (3.6-5.1 g/dL)
C-Reactive Protein 0.1
Hemoglobin A1C 5.5
(No microalbumin tested in Feb)
Uric Acid: 5.5 (2.5-7.0)  *Therapeutic target for gout patients: <6 br="">Cortisol (total serum): 21.9H (Cortisol a.m.: 4.0-22.0 mcg/dL)

November 2012:
Creatine: 0.64
Bun/Creatine ratio Normal
Microalbumin (random)  314H <30 br="">Blood Moderate (2+) negative
C-Reactive Protein 0.1
Hemoglobin A1C: 5.3
Plasma Renin ACT, LC/MS/MS  8.37H (0.25-5.82 ng/mL/h
Uric Acid: 5.3

July 2012:
Creatine: 0.66
Bun/Creatine ratio Normal
C-Reactive Protein 0.1
Hemoglobin A1C: 5.5
Uric Acid: 5.7

April 2012:
Creatine: 0.67
Bun/Creatine ratio Normal
C-Reactive Protein 0.1
Hemoglobin A1C: 5.5
3A Adnrostanediol-G 30L (60-300 ng/dL)
Uric Acid: 5.5
DHEA Sulfate: 448H (25-220 mcg/dL)
Cortisol: 10.9  (Cortisol a.m. 4.0-22.0 mcg/dL)

Obviously, between the cortisol, microalbumen and the uric acid, SOMETHING is cookin' in my kidneys. I have been wanting my docs to adjust/tweak my blood pressure Rx for months now, as I have been having "break through migraines" which are not in line with my usual, predictable menses-related migraines.  Endocrinologist mentioned something about the possibility for Cushings. (Yet no retest for anything. Yet. We have more pressing matters. Read on.)

Yes. I have about seven thyroid nodules, one of which is problematic, as it's nearly an inch in size, is close to my windpipe, and has "unclean margins." Hurry up and wait for four days to hear back from the diagnostic center, to find out that HURRY UP AND WAIT the earliest they could get me in for a fine needle biopsy is NEXT FRIDAY, which means that it will be nearly two solid weeks (from today) until I finally know if this nodule is cancerous or not, if so, what type of cancer is it (papillary vs follicular, for example), and if it's not cancerous, can we get this thing out of me LIKE YESTERDAY, M'KAY?

I've sent a thoughtful email to my bariatric office to find out, if, worst case scenario, if the thyroid (whether partial or entirely) needs to be removed, will this adversely affect my body's ability to absorb calcium, as being someone who is living post-op gastric bypass I am already contending with vitamin absorption issues, I want to know how this will impact me.

At this juncture, I'm not getting morose or morbid. I want as much information I can muster as possible, regarding how am I going to live, quality of life wise, post-op, should my thyroid be removed. I'm not indulging in death fantasy yet. Ideally I'd like to live to a nice old age like my late 80s, have a good meal, a few good laughs my last day and perhaps lay down for a nap, and it'll be GOOD NIGHT IRENE. I do NOT want to even think about dying a grizzly death of cancer, being taken apart piece by piece like my grandmother was for seven years following an oral cancer diagnosis. Nope. I just want to know what's it going to take for me to get through each and every day. Pills? Supplements? What's one more pill in the grand scheme of things?

Like I've said to friends, I don't know if I'm THAT strong, if I'm THAT much of a stoic, or if I'm THAT much in shock about the possibility of this being cancer.

And if I had my 'druthers, I'druther and just assume get all my surgeries/procedures all done at the same time or the same week, so I can get on with the business of recovering and more importantly get on with the business of LIVING. As it stands, I have my ablation and tubal ligation scheduled for next month at Mt. Sinai, and I'druther get my nodule-ectomy or thyroidectomy done at the same time, as the doctor I'm seeing for that is at that hospital too.

Sis and aunt both are aware of what's going on, yet neither one of them have texted or called me to see how I am doing. In stark contrast the very few folks at work (boss) as well as a friend of the husband's (who has adopted me, as sort of an adopted older sister) seem incapable of NOT asking how I am doing. Heavy duty stuff I'm going through for sure, but no sense in worrying until I know, DEFINITIVELY, what I am going to worry about. 

PS: FUCK YOU QUEST DIAGNOSTICS! FUCK YOU SERIOUSLY AND SIDEWAYS. IN YOUR PROVERBIAL EAR AND REAR END.

Dayenu! (It Would Have Been Sufficient...)

Seems like I'm putting the DIE in Dayenu...

If I just had to deal with PCOS & Syndrome X, dayenu.
If I just had to deal with fatty liver syndrome and hypertension, dayenu.
If I just had to endure RnY to turn some of that shit around, dayenu.
If I just had my joint pain, herniations, carpal tunnel, and plantars fasciitis, dayenu.

If I just had my "optic nerve druzen," dayenu.
If I just had my adenomyosis, endometriosis, and infertility, dayenu.
If I just had my kidney issue, hypertension (yes, a 2nd utterance), and migraines, dayenu.
If I just had 7 thyroid nodules, one of which is "suspicious," aka has "unclean margins," dayenu.

Summation: Monday I had three appointments. The trifecta of suck as it were.

1st appt: Nephrologist. Nothing new. Cortisol still high. Pee in a cup. Still no resolution on my blood pressure Rx, which we have been talking about changing or tweaking for months now.

2nd appt: Ultrasound of thyroid. Oh yes. Fabulous. Asshole doctor is a no-show, but diagnostic center gave me choice of continuing w/a different radiologist to read and interpret the findings. Okay. Fabulous. Seven nodules (thought I had just one), with one being close to an inch in diameter, and with "unclean margins." RED FLAG. Of course, HAD the asshole doc been there, I could have seen about getting a fine needle aspiration done THAT DAY, but no. I'll have to burn another day (or half) a day to come back into the city for this nonsense. Which means, I have to wait yet again for an office to call me back to let me know when they can fit me in, and of course, they cannot get this shit done today, or tomorrow or even this week. My anger is righteous, and brewing moment by moment. I went into this appt armed with the knowledge (thanks to Dr. Google) that if it were thyroid cancer, there's an 80% chance it's benign. Radiologist contradicted and said it's closer to 90%. Okay. So I exit the building, get pinged by the husband, and find out his grandmother passed away earlier that morning and he wanted to go home asap, but would wait knowing I had a 3rd appt later this afternoon.

This day is getting better and better.

3rd appt: Endocrinologist. Of course nephrologist never forwarded him any information from our appointment earlier in the day, so the blood pressure Rx discussion gets shelved YET AGAIN (I'll tell this to my migraines and heart flutters, I'm sure there's therapeutic benefit in that, right?). He calls me into his office, the inner sanctum, instead of the exam room. Glum as a chum he informs me that things aren't good, and I need to get a biopsy done ASAP. And oh yeah, remember that 90% the radiologist quoted? Yeah, well that's closer to 75%-70%. Plus, with the size and location of that 1 inch motherfucker? Even if it's not cancerous, that doesn't mean that surgery is out of the question because if it continues to grow, it's a choking hazard. As it stands, I can feel it when I swallow, and I have discomfort when I swallow hard tablets and supplements.

And of course, the place that does FNAs don't do them on the days I already HAVE appointments, which means ADDITIONAL time off. And of course, given the fact that the thyroid is MILES away from my endometrium and fallopian tubes, when I have THOSE procedures done next month, I cannot get the thyroid done at the same time, so I can recover from all of that mess at the same time. Oh no.

I'm bearing my burden well, thankyouverylittle. I'm just not bearing the burden HAPPILY.  I'll power thru the best I can like I always do, but yanno what?

DAYENU! Enough. Just, fucking, ENOUGH already.