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.