Supplement Comparison: Omega-3 vs Krill et al

Omega 3 vs Krill Oil vs Cod Liver Oil

On the Surface, both, Omega-3 and Krill oils, supply Omega-3 fatty acids, HOWEVER, the source fish are different, and more importantly, the potency of EPA and DHA differs MARKEDLY.  There are claims online that Krill oil “typically contains more EPA,” However, I did not find this to be true (see chart).

Krill oil contains fatty acids similar to fish oil, and these fats are thought to be beneficial in helping decrease swelling, lower cholesterol, and make blood platelets less sticky, and less likely to form clots.

Omega-3 and cod liver oil are two different oils even though they both come from fish and have a similar fatty acid profile. Fish oil is extracted from the flesh of tuna, herring, cod and other deep-sea oily fish species. Cod liver oil is a good source of omega-3 fatty acids such as EPA and DHA but doesn't have much (if any) in the way of omega-3 fatty acids.

I’m not going to devote any more time to cod liver oil—as that wasn’t part of the original discussion (which I had with my chiropractor), but thought I didn’t want to exclude it from the entire discussion.

I found that the Mega Red Advanced 4-and-1 which contains both, fish oil and krill oil to be lacking, despite its high regard in its reviews (as well as great marketing); however, that might be related more to the antioxidant astaxanthin which is in the krill oil rather than than the EPA/DHA that their source fish, pollock, provides.

My theory/hunch is: whatever benefit people MIGHT get from a krill oil supplement isn’t due to the EPA/DHA, but actually from the astaxanthin.

• Marine Bioactives: Pharmacological Properties and Potential Applications against Inflammatory Diseases:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366677/ 
•  A worthy mention regarding astaxanthin and cancer: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515619/

To cover all bases, I’m ALSO going to contrast/compare that Omega XL supplement that Larry King promotes on TV into my analysis. 

Despite the fact it has “Omega” in the name, my theory/hunch is:  whatever benefit people might derive from that (VERY EXPENSIVE) supplement actually comes from the Green Lipped Mussel extract, which is high in boron.

SPOILER ALERT: At $1.11 per pill (PER PILL!), rather than buying the Omega XL, perhaps it would be more economical to consider buying a good quality omega-3 fatty acid supplement, and then buy a separate and less expensive boron supplement.

•  Nothing Boring About Boron:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712861/

I *thought* I did a thorough contrast/compare, though I think I should have added how many pills make up the dose, as each manufacturer has different # of pills to make up the totals listed below.

Brand	# Pills	$ Per Pill	EPA (mg)	DHA (mg)	Total # Fish Oil (mg)	Source Fish	Notes:	Purified/Distilled
PacificCoast NutriLabs 2000mg Fish Oil	60	$0.17	800	600	2000	Herring, Mackerel, Salmon, Sardines		YES
Nordic Naturals - Ultimate Omega	90	$0.33	650	450	1280	Anchovies, sardines	"Other" Omegas: 180 mg	YES
Mega Red Advanced 4-in-1	80	$0.36	314                               (combined)		339	Krill, pollock	Total Fish Oil + Krill = 500 mg (Krill contains astaxanthin)	YES
Omega XL	60	$1.11	12	7		?	Green Lipped Mussel Extract (high in Boron)	?
Carlson Super Omega-3	120	$0.12	300	200	600	Macerel, sardines	"Norwegian Fish Oil 1,000 mg"	?
Carlson Lightly Lemon Cod Liver Oil	300	$0.07	85	100	1000	Cod liver	"Norwegian Cod Liver Oil, 1000 mg"     "Other" Omega-3: 45 mg	?

I, myself, have been on 3 mg of boron for a month or two now, and I originally started it out of concerns for bone density, as I'm getting older, plus I had gastric bypass six years ago. However, I might have a chat with my nephrologist (who treats me for hypertension), as the boron might impact my kidney function. I also started my husband on it due to his periodontal issues which have morphed into perio & endodontal issues. 

Astaxanthin tibit: From what I can find online, astaxanthin is derived from krill or shrimp or salmon.  And this site (while I don't know if it's credentialed) has some interesting information on the merits of consuming shrimp.  Cliffnotes: 4 oz of shrimp contains about 1-4 mg of astaxanthin--the true amount of astaxanthin in shrimp pretty much vascillates depending on if it's wild caught vs farmed, as the whatever farmed shrimp is fed impacts the astaxanthin levels, whereas wild caught shrimp feeds off of kelp and other sea vegetation.  Just a hunch here, but when buying shrimp or salmon, you want it to look as pinkish-orange as possible (I suppose this is why some farmed shrimp or salmon looks dull in comparison to wild caught).  

Just sharing my notes and take-away a-ha! information I've culled thus far, and by no means am I suggesting someone use my information INSTEAD of talking with their doctor FIRST before starting these supplements. I've made up my own mind with what information I have on hand, and making judgment calls for MY OWN health; however, I do think that someone interested in adding astaxanthin (or boron, for that matter), SHOULD run it by their doctor first, to see if it's a good fit for them.

A preliminary caution on astaxanthin (in supplement form) can be found on this site.  Again, that, too, is just a website, and not a replacement for talking to a doctor, but I think reading and thinking and wanting to be an advocate for your own medical care is KEY to optimal health. At best, the doctor might agree it should be included in your daily regimen, and at worst, the doctor would say to avoid it entirely (and hopefully provide a couple of reasons, too).  

Physician Fatigue Part 7: Overwhelmed

Here's the quick and dirty inventory of doctors I see, and with what frequency:

Add to this mix the annual sonogram & potential biopsy of my thyroid nodules, too, and it's a formula for disaster, regarding time, time off from office to accommodate all these appointments, plus the added STRESS. 

It's pretty overwhelming, especially on days like tomorrow, where I have to get up at 6 a.m., to drive to Greenwich CT, to sit and wait 15-30 minutes for my physiatrist, have an hour with the massage therapist (to maximize the trigger point injections I no doubt will get), possibly have an X-ray of my shoulder, and I somehow STUPIDLY scheduled this appointment on the same day when I have occupational therapy on my elbow during  my lunch hour.

UNCLE!  

The end of March brought with it SURPRISE! His and Hers Root Canals! I has the first step on 4/22 and on 5/11, I will hopefully have it finished. Normal people's root canals take about 45 minutes for the first step. Mine took 2 hours and 15 minutes. 

So with this, as well as the added worry about my husband's root canal (which is now a TREND, as he had to get the tooth that is immediately ADJACENT to the  tooth he had previously root canaled two years ago done, too. And now, it appears as if this has now evolved into periodontal-endodontal disease for him.

So between the scheduling, worry, and COSTS of TWO root canals, I've now hit my limit. This month is a rough month, time-wise. No chiropractor or physical therapy appointments can be scheduled on Saturdays--due to other scheduling obligations on my part. That there throws every single week into a dizzying game of BEAT THE CLOCK, and just adds to my stress and anxiety. 

 

Breaks my heart to discontinue physical therapy--but my once a week treatments aren't really helping me. And as much as I adore being on the traction table for my neck and low back, I am experiencing minimal effect, and it's very short lived at that. This is no indication of the talents of the physical therapist--he's great. It's just a sign that there's not much to be done to help.

I am now well over six months deep into my relationship with the physiatrist, who, seems to be keeping me in a holding pattern with trigger point injections, the occasional cortisone injection (which I'm really philosophically not supporting), as well as Synvisc (or was it Euffexa?) injections. The synvisc injections HAVE helped with the knee, but to a point, and it has by extension helped the referred pain in my hip, TO A POINT, but I am still experiencing pain, and just would rather explore the idea of a knee replacement already and quit pussy footing around. I'm giving this 1-3 more visits, which will bring me to the first 1-2 weeks of June, and then I'm just going to call it quits.  I can't sustain this much longer, either. 

The one care provider that I feel my most marked benefit from is my chiropractor, of whom, just now, I scheduled an appointment for tomorrow night, and I'm going to run this by him, ditching who I can, and saving my sanity--to a degree.  I. Just. Can't. Even. Anymore.

Additionally: I dumped an account on FB, and haven't gotten so much as a text from anyone saying, "Gee, what happened?" And for the remaining account, I cannot tell if I am being ignored, if I'm getting minimal interaction due to the never-ending fuckery that is the FB algorithm, or if I actually DID something to warrant being/feeling shunned--especially by long term, IRL friends, and TBH, I don't see anyone anymore, and given that online is the only real venue for interaction (see also: no texts on phone, no emails no nothing anymore), I'm wondering if I am just too obtuse to realize that I'm a snooze or I'm offensive, and what friends I have/had are just phasing me out--yet inexplicably, aren't unfriending me on FB. I am so anxious and depressed and overwhelmed, I cannot decipher it all anymore. And given that one IRL friend of mine seems to have dumped me (it's been six weeks and no contact since) after I let it be known that I don't feel important enough or interesting enough to warrant one hour during lunch without her being glued to her cell phone. Fifteen year friendship down the shitter due to being honest.  So, whatever. Thereygao. I better hit "publish." Fuck it.

*ETA: I dumped that last FB account in August 2018 and I haven't looked back.

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 6 Endodontic Edition

Just when I thought I had streamlined the whole thyroid sonogram situation, and eliminated a redundant or additional doctor by way of consolidating my neuro and optic-neuro into one specialist, Saturday I was informed I needed a root canal.

I had a 37 year old filling that a small part broke off, and despite complaining about it to my dentist, he did nothing about it, as he couldn't find the break, and didn't do any further/comprehensive imaging to see what was going on. So I've gone let's say, 6-12 additional months with this intermittent twinge when I'd bite down to chew a steak or the twinge would hit if I ate/drank something too hot (obviously an indicator something was rotten in Denmark!). 

Amalgam fillings typically last about twenty years, so considering I had this one for nearly 37 years, it didn't owe me anything. I got more than enough mileage out of it! 

Saturday I followed up with my husband's dentist as mine pretty much has one foot out the door to retirement, and both dentists are in the same practice, so it's not like I had to seek out an entirely new office and become an established patient, so score one for convenience.

Anyway, I'm in the office on Saturday for what I thought would be an exam and evaluation, and whatever work would be started in a subsequent office visit. But the dentist said he had an hour until his next patient and if I wanted to do so, he could drill/grind out the old filling and take an assessment--but warned me that he wouldn't really know what we're dealing with. And of course, it was a gamble on my part. But he managed to numb me enough to work on the tooth, and I need a root canal.

Meanwhile, my husband is in the other cubicle getting a dental cleaning, and the dentist was called in to do a quick exam on him. And no great surprise, he needs a root canal as well. He's been struggling since roughly December with some pain/discomfort, which we thought was just a sinus infection. We traveled to India, and he saw a doctor there, who prescribed antibiotics, and that helped a bit. And weeks after returning, the pain returned, and our GP couldn't figure it out, and referred us out to an ENT, who scoped him and couldn't find anything. And here it is about two months after returning from India, and it turns out it wasn't a sinus infection at all. He's got an abscess in the tooth immediately adjacent to the one he had root canal in nearly two years ago (and that root canal went bad, and he ended up losing the tooth and now has an implant). 

While I am upset about the prospect of having a root canal, as I am the one in our little family who has the good teeth, I am MORE upset about Maharajah's, as he's gone through one struggle or another with his teeth and gums.  

He had his root canal two days ago, and the pain seems to be amping up as of yesterday, and this morning there's a bit of swelling in his cheek in the area of the tooth that was worked on. So, a call was made this morning for possibly some pain meds and antibiotics for him--I'm pretty much surprised by the lack of post-root canal antibiotics, especially given he's got an obvious abscess, but what do I know?  

Anyway, my root canal is scheduled for 4/22, and when it comes to my mouth, I need my hand held like a little kid. And I hope that when I finally do get the crown installed, that I will get as good of mileage out of it as I got out of the amalgam filling! 

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 5

As I'm still waiting to find out if 3/29 will be a good date for another radiologist entirely--I've decided to CUT AND RUN. This is to say, that if I am not going to see Dr. Doshi, the doctor my endocrinologist recommends, then I'd just assume find another doctor entirely and try my luck that his office/department, at another hospital system entirely, is run with a bit more give-a-fuck. 

I'd say five to six years of this nonsense is long enough. I've been a good-enough sport about all of this, but I honestly don't have time for this level of ineptitude.

Physician Fatigue, Part 4: More Insanity: Radiology Associates Klingenstein Pavillion

I don't care anymore. I'm naming names. I don't know or care if anyone reads my blog at this point, but hopefully this will POP up in a Google search if someone decides to search any of the players involved. Or perhaps some administrator at Mount Sinai Hospital in NYC might actually care about this.

For approximately 5-6 years now, I have been going to Mt. Sinai Hospital's Radiology Associates at the Klingenstein Pavillion, for both, sonograms and biopsies of thyroid nodules.

While I have no complaints about Dr. Amish Doshi (who was highly recommended to me by my endocrinologist), the radiologist in question, I *DO* have a serious problem with everything about the administrative aspects of just MERELY getting in to see Dr. Doshi.

The MERE act of scheduling an appointment date/time has now reached epic proportions of stress. Perhaps I should get out a slide rule, consult an astrological chart, and perhaps offer up a blood sacrifice--perhaps that might make the experience easier.

I have been trying since 2/14/17 to schedule my appointment. For one full month, I have been playing telephone tag with Janice (I don't know what her last name is, all I do know is she signs off her outgoing messages with "God Bless," well, let's just say, I don't feel all that "blessed").

The first week of calls went something like this:

1. I call and leave a message. I clearly state who I am, and that I am calling to schedule an appt. I VERY CLEARLY state to call me back at my work phone AFTER 2 p.m. Note: I stated AFTER 2 p.m., because with MY luck, she will call back DURING MY LUNCH, thereby continuing this telephone version of "water torture."

2. She then calls MY ENDOCRINOLOGIST stating she could not call me back WHEN I wanted, and informs THE SECRETARY AT MY ENDOCRINOLOGIST'S OFFICE that I should call her back with two potential dates for my appointment.

3. Like a trained monkey, and in an act of utter futility, I call, and AGAIN, I get her voicemail, and AGAIN, I very clearly state who I am, what dates I am available for the appointment, and VERY CLEARLY state she should call me at MY OFFICE PHONE.

4. Like an idiot, she calls me at my HOME PHONE, and now has elevated this game of telephone tag to SISYPHUSIAN-INNER-RING-OF-HELL-ITSELF-FUTILITY, by informing me that Dr. Doshi was away, and she won't know until he returns whether those dates will work.

5. So I sit and seethe for two more weeks until March 8th, when I call and leave a voicemail following up YET AGAIN. No reply was received.

6. Which brings us to this week, and granted there was a blizzard on Tuesday 3/14. 

7. I called again on 3/15. Her outgoing voicemail stated she was out.

8. I called again on 3/16. Her outgoing voicemail stated she was out and at the tail end of the message she stated someone else's name to direct my call. I called that person, and left a voicemail. And got no reply.

9. I called again, TODAY, 3/17, and Janice is in. Apparently, she left a voicemail TODAY ON MY HOUSE PHONE stating Dr. Doshi was available on 3/22--well now 3/22 is no longer good for me, as another co-worker will be out that day for medical stuff, and I need 3/29.  (My head is just about to explode at this point). I then say, "Okay, when in April is Dr. Doshi available?" And this was met with, "You need to call me back regarding this as I don't know what his schedule will be like in April." I got loud and I got firm and stated the ridiculousness of it taking a FULL MONTH to merely try to get an appointment FOR A SONO AND BIOPSY and this unnecessary stress is doing NOTHING BUT STRESSING ME OUT MORE. I was put on hold YET AGAIN (and at this point, I am really just sick on a Pavlovian response level of sickness when I hear the piano hold music). 

Just when I was about to hang up in frustration and reconsider the idea of the ultrasound and sonogram ENTIRELY, she finally got on the phone. I got loud and somewhat (for me) belligerent. And finally at that point she made the suggestion that I might see Dr. Aggarwal. At this point, I was like "At this point I will see anyone--can we just schedule this so I can get this shit done?" And all this said, this is not even a given! I gave 3/29 as the date, and I want the first appointment of the day--she still needs to call me back to confirm. And no doubt Janice, in keeping with her track record, WILL call me back at ANY OTHER NUMBER OTHER THAN THE ONE REQUIRED.

Then there are other systemic administrative failures--

EVERY. SINGLE. TIME. I go in to see Dr. Doshi, there is anywhere's from 1-2 hours of my time pretty much ROBBED from me. Yes. I am being MUGGED and what is stolen is the most vital, most precious commodity: TIME. Time I will never get back.

Now mind you, going in for an ultrasound with the very real possibility of a BIOPSY is a stressful thing.   A one-to-two hour wait on top of this, only exacerbates the anxiety and stress.  

Last year's appointment had been scheduled, then rescheduled at least twice that I could recall. Rescheduled so many times, that I did not remember to change the time in the calendar on my phone. So imagine my surprise, showing up at 10 a.m. for an appointment, and sit there for over an hour, and realizing every one else who came in AFTER me had been tended to--and when I asked the receptionist when would I be seeing the doctor, she informed me my appointment was at NOON. At this point I blurted out, "At what point were you going to inform me that I showed up TWO WHOLE HOURS EARLY for my appointment?" She suggested I go off some place to get coffee or food, but that is not the point, in order for me to go for lunch, I'd have to walk to find a place, which then takes time, then WOLF DOWN MY MEAL, which takes more time, and then there's the matter of the time it takes to WALK BACK. 

I don't recall if it was during this particular visit or the year before where I actually lost my shit to the point where I insisted on speaking with a hospital administrator regarding this.  

Additionally "telling" about how poorly run this particular department at Mt. Sinai is run--there is never, ever a survey sent to me. Mt. Sinai Doctor's Practice sends out a survey. Every other office and department I have been to (nephrology, gynecology, cardiology, hematology) runs efficiently and timely like a Swiss watch. Radiology is the only department where I have endured piss poor customer service from the administrative staff. 

So here it is, nearly an hour after I've had my most-recent interaction with Janice, and my head is pounding and I've got a raging case of oggida, and no recourse or resolution, so unless I find some place else to get my sonogram and FNA done, I have this to look forward to for the time being. And it just sucks (to put it mildly). 

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.

Myo, myoGOD Am I Tired

I haven't boosted the 500 mg of myo-inositol, and continue to take it in the evening right before dinner. And today, which is little more than a week into taking this new supplement, my fatigue levels are EPIC.

Going to do a finger stick tonight before dinner, 2 hours after, and then tomorrow morning do another stick upon rising to see what THAT number is, just to see how my glucose is responding well over a week into this experiment.

My-oh-Myo-Inositol

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

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

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

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

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

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

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

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

Before Dinner: 85
2 Hours Later:  83

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

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

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

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

Physician Fatigue, Part 2

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

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

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

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

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

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

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

I've done everything imaginable to treat it:

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

ZERO relief.

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

PRP
EPAT
Acupuncture

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

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

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

Physician Fatigue, Part 1

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

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

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

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

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

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

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

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

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

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

Well, two things:

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

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

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

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

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

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

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

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

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

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

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

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

Thursday's Trifecta, 12/15/16

Last Thursday was a triple threat Thursday.

First, I finally got myself into a hematologist for a consultation on my FVLM. Personable guy, much more so than I imagined. The consultation was consistent with most of my interactions with doctors, I show up early (and to my surprise, they had a cancellation and got me in earlier than my scheduled appointment--SCORE!), and I had questions prepared.  

Granted my questions ran somewhat "scattershot" from one extreme to the next, all an indicator that I'm reading up, not only on the FVLM, but the affects of my dietary supplementation on my blood chemistry, as well as my joint issues (which range from chondrocalcemia and borderline gout or pseudo-gout).  

My first question was innocuous enough, regarding how (if at all) my particular blood viscosity might impact or skew my blood chemistry (answer: not at all). I had concerns regarding my RBC and hematocrit being elevated (apparently the hematocrit is skewed because my testosterone was elevated--so at least I got something useful to take my worrying down a bit!). Once I got to the last question regarding the chondrocalcemia in my knees I inquired if I were at risk for hemochromatosis, and it was with THIS question the doctor very sweetly smiled and said, "You need to stop reading." 

Another goodish thing to come of the hematologist's office visit: the weigh in. Mind you, due to pain issues, I haven't gone to my endocrinologist since August (won't see him again at this rate until February), and I've had a lot of anxiety about getting weighed. Due to not walking as much as I normally do, I've felt lethargic and bloated and thinking SURELY I have gained more weight. The weigh in showed that I was within 1 lb of my normal range. I'd like to shed some weight before my February visit with the endocrinologist, and feel a bit confident that it's even possible. I just need to sleep more and eliminate my late night snacking.

Ever since the middle of August, I have been having severe, acute pain issues with my knee, with a lot of referred pain in the form of trochanteric bursitis and pain in my low back. 

On 12/9/16, I started getting Synvisc injections in my (right) knee, and I started walking with a cane, either at work (where it also serves as a prop to convey that I have "issues") as well as on days I'll be walking a LOT. Well, Thursday 12/15 was A LOT.

After the hematologist, I managed to head off to a yarn store, then get a slice of pizza, as my next appointment was at 2 p.m. Even with a cane, by the time the day was over, I managed to have hoofed roughly 4 miles--and not with any additional pain or discomfort (well, pain or discomfort beyond the very tips of my long toe on each foot being tender).

My next appointment was a follow up with the kidney doctor, who I see twice annually for management of my blood pressure. The appointment was enjoyable--always is with this doc.  I had some questions prepared about wanting to get tested for hyperoxaluria, hemochromatosis, as well as cystatin-c. The nephrologist asked me what I thought the first two things were, and when I answered him correctly, and we got to the third item, he said, "I know what you're looking for!" and he immediately added that test onto the blood sample taken at the hematologist's office. 

I also had a question about the possibility of changing my diuretic to something that did not involve thiazides, as I wanted something that was a bit more therapeutic or even preservative of the renal function.  All my chemistry is "rock solid stable" as the kidney guy said, and he made a good argument for staying on what I'm currently on and we'll change it if anything else changes. 

It's exceedingly nice to be treated as a full participant in doing the differential on my health issues.

After the kidney guy, I managed to have some time to make a quick trip to Kalustyan's to pick up some necessary items (as well as a few gifties), before heading to the last appointment of the day.

And the last practitioner I saw to round out my Thursday Trifecta was the travel clinic, where I went to get an update on my typhoid vaccination and get a broad spectrum antibiotic (just in case) for my trip to India which is coming up.  

4.4 miles. 23 flights of stairs. With. A. Cane.