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.

Struggling

All I can do right now is just whine, or curl up in the fetal position and make communicate in noises that only dogs and dolphins can decipher.

I'm really struggling with depression right now. Struggling to stifle the urge to just cry at my desk. I'm overwhelmed with resentment at work, this isn't what I signed on for 15+ years ago and now I'm trapped. No one will hire me in my current position, because currently I make more money than anyone will pay someone at entry level; furthermore, no one will take a chance on me if I wanted to transition to a project management position. Round and round I go, obsessing on what needs to get done, and then realizing, yet again, that it relies upon OTHER PEOPLE to help me make that happen, and the realization I keep coming back to is that OTHER PEOPLE just fucking disgust and disappoint me.

It's Thanksgiving week, and I'm depressed and anxious, and wondering why the hell I do this to myself every year. I enjoy the planning, but when the day comes closer I regret ever doing this. It's a lot of work in a general sense, and even more work when you factor in I am physically not up to it. Even less up to it when you couple that I'm depressed.

More details about what's going on with my mom and my brother are on the other blog; however, those two situations haven't resolved themselves, and there's the combination of angst and relief (but really much much more angst than relief) of living so damned far away from my mother and my brother for me to even BE THERE in any sense of the word, to help. But to be graphically honest, they are both beyond help. And being the elephants that they are, they cannot swim, and they will make very, very light work of dragging those (who attempt to help) down into the abyss with them.  

I sent in my resume via LinkedIn to another government job--and it remains to be seen whether I'll even be called in for an interview. I'll be equally happy or pissed, either way. The stoic in me sees that the end result, whichever it will be, will ultimately be met with the same emotion. I recognize if I do land the job, it'll be akin to going from the frying pan directly into the fire itself--but I'm ready for a different kind of awful, and perhaps a fresh start with some new assholes. And again, I don't see this going anywhere. It's yet another of my acts of futility to try to bolster or ease my mind that I do have value, even if the assholes where I work do not validate that.

My stomach is up in knots, and my To Do List is extensive, and I'm hoping it'll save me by way of distraction, however, there's the matter of being trapped here at work, when I should be home, either working or napping (either would be equally productive at this point).

Pain, in one form or another, is my companion. Not a day goes by without me being aware that something hurts, or that I can't do something (or do it as long as I'd like) because of my limitations.

I had to reschedule my therapy session for this week, because the director insists that I come into work tomorrow by 8:30, robbing me of that additional hour sleep I need so desperately in the morning, to cover staffing because the other two secretaries are both scheduled out--something that should never have happened, because the director insists there are two secretaries working at all times--YET when it comes to me, it's perfectly acceptable. Fuck her. So I don't even get to talk to my therapist this week because of the director. Yet one more reason for me to get the hell out of here. The double standards and bullshit are too much.

I don't know why I even bother blogging. I doubt anyone is reading. It's merely a scream into the abyss at this point. It's like that bit about "if a tree falls in the woods and no one is around, does it make a sound?" If I blog and no one reads it (or no one reacts to it), what's the point? Do the words and sentiments exist? But then again, there I go again, that fucking trap of OTHER PEOPLE.   

I keep circling back to worrying about "is this as good as things are going to get?" and then flailing (at least internally), as I am most-decidedly NOT content with this aspect of my life, and yet, I am powerless to remedy it. I don't want heart emojis or "thoughts and prayers," or "thinking of you," or even "I wish I could help..." Just fucking help me. I'm capable. 

Right now I am living each day this week on an hour by hour basis, trying to not just power through until my Thanksgiving feast is over, but also powering through until Friday evening, as I will be working on Friday, so I am trying to focus on Friday evening, and then take a muscle relaxant and just sleep for 12 hours if I can.

And there's all this, and then the existential, interconnected angst of realizing that never again will I be able to go to my mother's house for Thanksgiving (or for anything else for that matter). My mother hasn't lived in her house since July, and soon her house will become someone else's house. I cannot even process this loss, as there's just too much other shit that needs my attention this week.  

And on top of this, well-intentioned dinner guests pinging me, asking me what they can bring. JUST BRING YOURSELF. When I say that, I truly mean it. I have everything under control with food. Just come, and bring your appetite. And now I have to worry about making sure everyone else feels like a participant--which they should be, participating. I'm not in a good mindset for this.

And whatever. Even FB seems like screaming into the abyss or a political echo chamber, and it's not even a distraction anymore for me. I've been gradually culling people off my friends list of people who don't go out of their way to interact with me--so why should they be on my list? They know how to find me if they want me. Perhaps I'll end up whittling the "list" down to a solitary splinter, and... well. Whatever. What's the point of all of this. 

I better quit my yammering and hit publish. Fuck you, Tuesday.

 
 

Struggling.

You know I'm struggling when/if I say I broke down and allowed myself to get not one, but two cortisone shots in the last 6-8 weeks. 

First shot was in the bursa in my hip. According to my math, my right hip has been hurting since my first trip to India in 2012, from sleeping on a rock hard, ayurvedic type bed.  It injured the bursa, and set me up for more issues, or it compounded other issues (like IT band syndrome).

Second shot was in my shoulder, as I've had problems with my shoulder, going on nearly 3 years. I have had symptoms of chronic elbow tendonitis which have been resistant to treatment (I've had a cortisone shot in the elbow, regular visits with a physical therapist, topical voltaren gel, ultrasound, TENS/EMS, and even cool laser). I had the shot in the shoulder and for about a week, the elbow seemed different; however, now it's nudging itself back to where it was before the shot.

I don't have the time (3 visits a week for 5 weeks) or the money (roughly $2500--and insurance doesn't cover it) for EPAT, which I've been promised would help. But what if I go through the logistical inconvenience of those 15 visits and spend all that money and be no better off? What then?

Next thing on my bitch list today is the fact that in August, my endocrinologist broke up with me, informing me he was going to retire by year end. Then September brought with it that little drama involving my glucometer readings and digestive enzymes--to date, he still hasn't bothered to reply to my last email to him. 

The lack of a reply disappoints me, as in August he informed me he is my doctor until the end of December. Well, if he's not replying to me, then he's not doing much in the way of doctoring. Last week I received the stock letter that every one of his patients received--and they didn't even go to the trouble of doing a proper mail merge, to personalize each letter with our names. The letter might as well have opened with "To Whom It May Concern."   

Despite the fact he's sold his practice to another doctor (or two), I've found someone closer to home and who takes my insurance, and who is a known entity to two friends/co-workers, who are seeing this new doc for thyroid issues, and I feel that is where my focus should be right now. So in January, when I return from what will be my most-recent travels, I'll set up an appointment. I have my "bundle" already for that visit, too. Blood work, etc. And I've been chipping away at sorting through the mountain of paperwork, and compiling a spreadsheet to document my progress since my bypass in 2011, to make things easy for the new endo to get a handle on me as a patient.  

And lastly, this past week I visited my gyno for my annual exam. The visit went smoothly no real complaints, and I had my mammogram done the week before, so that came back clean. I mentioned how I was interested in getting "some work done" by having a "tuck and suck," possibly having my pannicula removed/tummy tuck, and having a fist-sized gob of fat removed/sucked out of me, not for vanity reasons but because I'm tired of carting this flab around, and I want to be more comfortable in my own body and have my clothing fit better.  

So projects for 2018: 

1. New endocrinologist;
2. Seek consultation with the plastic surgeon my gyno recommended (as well as seek a second opinion). 

All this, coupled up with blatherings at my other blog wherein I detail the craziness going on with my mother, and my brother, etc, just adds up to me being anxious and depressed, and wanting to power through Thanksgiving, and power through until I am in Singapore and places beyond.

Which reminds me--I need to buy a biodegradable urn.

 

The Digestive Enzyme Debacle

I did some reading up on digestive enzymes (amylase, lipase, and protease, in particular), and justified taking them for two reasons:

1. As you age, your enzyme production declines; and
2. As I had a gastric bypass, no doubt, that decreased my digestive enzyme production (along with my HCL production.

Well. LESSON LEARNED!

Amylase supplementation does NOT play nice with my reactive hypoglycemia. And fortunately I had the foresight to zap a blood glucose reading about 3 days into this experiment. 

9/18 I started the supplement.
9/21 I started feeling like shit. I took a glucose reading and have continued to take readings (and being very very alarmed by it).
9/24 Was the last supplement I took.

How high is too high?

Well, my normal fasting glucose level is around 92-96.

This morning it was 141. Two hours after my first meal it only dropped down to 121. For me, this IS "alarming."

Right now I'm worried about whether it caused a cascade effect, triggering something in my pancreas. Only time will tell if my levels will revert back to my norm. 

In the meantime, I zapped an email to my endo (Yes, the one who is retiring), and I'm hoping he'll give me a QUICK reply back to reassure me.

I've also zapped emails to a friend who is an RN, a friend who is a PA, and another friend who is an MD, all hoping one of them will reply and put my mind at ease. 

My chiropractor and I always have conversations about supplements we're both taking, in a way, we're both comparing notes. And I mentioned to him about the glucose readings and asked him if HE personally thought the enzymes could be the culprit, or if I should just focus on lipase, since I lack a gall bladder. And he didn't see how it could impact my glucose--but then again, I KNOW MY ERROR, in asking a chiropractor about endocrine issues.  Lesson learned.

And now I wait, and hope I didn't damage what I've managed to either achieve or maintain after my bypass.  

Notes Re: Methylation, Homocysteine, Betaine, etc

Homocysteine & Methylation "Take Aways" 
Note: Methylation = Complex combination of actions whereby Homocysteine + “Certain B Vitamins” (i.e., b6, b9 (folate), b12) + Betaine, SAM-e, Adenosine etc etc = (recycled into) Methiones 

(Image from Wikipedia)

1. Homocysteine can be recycled into methionine or converted into cysteine with the aid of certain B-vitamins;
2. Normal homocysteine levels should be less than 13, with the ideal range being between 6-8, with hyperhomocysteinemia Dx at over 15;
3. Homocysteine levels are typically higher in men than women, and levels elevate with age;
4. MCV greater than 95 can indicate a methylation problem;
5. Blood or urine methylmalonic acid test for b12 deficiency (may be ordered as a follow up to a standard b12 test);
6. Daily diet should include one cup a day of dark green leafy vegetables, and daily protein intake should be between 80-120 gm;
7. Reducing AGE (advanced glycation end products) by diet and or supplementation can potentially lower homocysteine levels (and protect the kidneys);
8. Supplementation: All B vitamins, but IN PARTICULAR emphasis on b6 (up to 250 mg) & b12 (500 mcg), plus more than 400 mcg (RDA) folate (unless person has cancer), choline (precursor to betaine*);
9. NOTE: If one were considering supplementing with betaine to lower homocysteine levels, the IDEAL formulation appears to be BETAINE ANHYDROUS *NOT* betaine hydrochloride;
10. Digestive diseases, caffeine, some meds (i.e. acid blockers, methotrexate, or HCTZ), and no doubt, malabsorptive bariatric surgeries can impact levels of B vitamins in blood;  

Interesting articles:
Betaine supplementation decreases plasma homocysteine in healthy adult participants: a meta-analysis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610948/

Maximizing Methylation: The Key to Healthy Aging, by Mark Hyman MD http://drhyman.com/blog/2011/02/08/maximizing-methylation-the-key-to-healthy-aging-2/

Below the Radar: Advanced Glycation End Products that Detour “around the side” Is HbA1c not an accurate enough predictor of long term progression and glycaemic control in diabetes? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320176/

Lowering homocysteine levels with folic acid and B-vitamins do not reduce early atherosclerosis, but could interfere with cognitive decline and Alzheimer's disease https://www.ncbi.nlm.nih.gov/pubmed/23224755

BEETS & GREEN LEAFY VEGGIES & METHYLATION 
CONFLICT #1: Green, leafy veggies, lowers homocysteine yet elevates oxylates 
CONFLICT #2: Green, leafy veggies lowers homocysteine (which would lower risks for DVT, clots, stroke) yet they contain Vitamin K which would increase risks for DVT, clots, stroke. 

BEETS: Despite the fact that beets are high in betaine, which helps lower homocysteine levels in blood, they are ALSO high in oxylates, which elevates purines in the blood, which then elevates uric acid and contributes to gout inflammation. 

GREEN LEAFY VEGGIES: People who have blood clotting disorders (Leiden varieties, in particular), like myself should be wary of ingesting too much in the way of green leafy veggies, as they are also high in Vitamin K (“klottenfactor”) and can have a potential negative impact (i.e. clots, stroke, dvt, etc), and it’s this reason (as well as having had a gastric bypass) that I use a variety of supplements to make sure my needs are met. ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬

Notes on Benfotiamine (fat soluable, B1): 

Below the Radar: Advanced Glycation End Products that Detour “around the side” Is HbA1c not an accurate enough predictor of long term progression and glycaemic control in diabetes? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320176/ 

Effect of Benfotiamine on Advanced Glycation Endproducts and Markers of Endothelial Dysfunction and Inflammation in Diabetic Nephropathy

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3391239/

Lots To Process!

A while ago, I said how 2017 was going to be the year where I streamline the circus that has been my medical care, and eliminate redundancies, and try to pare down how many doctors/specialists I see.
 
LAST January, I saw my internist and had him arm chair quarterback my endocrinologist, who, at the time, sent me in for a 2 hour glucose tolerance test, even though most people know (I didn't!) that bypassers like me shouldn't have this test done for obvious reasons (a lot of bypassers end up with Reactive Hypoglycemia/Post-Prandial Hypoglycemia).  My internist didn't see much to be concerned about, though he did suggest to me that I find an endocrinologist closer to home and one who takes my medical insurance.

Two months ago, my husband and I were at the office where BOTH of our internists work, and we noticed there was an "In Memoriam" type book on the counter with a sign indicating that my internist had passed away. This saddened me greatly, and yet, oddly, it plays into the overall theme of what I verbally articulated 2017 to be, "The Year of Streamlining." Well, may he rest in peace, I was planning on acting on his guidance.

Monday was a regular appointment at the Endo for me, and I was steeling myself mentally to dispense the "It's Not You, It's Me" discussion wherein I let him know I can't financially sustain seeing him anymore. 

Right here is a perfect example of a nugget of advice my husband's grandmother used to share, "If you do nothing at all, in 75% of cases, your problems sort themselves out on their own."  

I walked into his office where we normally have a discussion before he examines me, and right off the bat, I noticed 2/3 of his books were off the shelves. And then HE gave me the news that he was selling his practice, and would no longer be seeing patients, and would be focusing his time on lecturing and teaching other doctors to do what he does.

I said, "Hey! You can't break up with ME! I was going to break up with YOU!"  

The examination went as it normally does; however, I refused to hop on the scale, since this is the last visit. And I blurted out, "Nope. Not this time. I refuse to hop on that metallic bastard! I want my last visit to end on a good note!"

While it would be nice for me, to go to whomever is buying his practice, it's just not feasible for an assortment of reasons--and really, WHAT do I know about this person? So, now I'm actively looking for a new endo, and my search is going Goldilocks style: one that isn't too old, and isn't too young, someone capable of monitoring my thyroid nodules, and someone local-ish, and takes my insurance, and basically gives me 2-3 days of my life back (not to mention, $$$ I won't be spending for a doctor who doesn't take my insurance).  Two of my co-workers go to an endo nearby, and speak highly of him, and he meets my criteria, so I need to get the new patient forms, and get things lined up so whatever medical records of mine can get transferred while my current Endo's office is still open and operating.

Even though I was planning on discontinuing, I wanted it to be my decision. And knowing my Endo, he's 85. I fully expected him to keep treating patients until the day he just ran out of steam and passed away, blissfully, at his desk in his office. Instead, there's THIS. And I know something must be going on with him for him to decide to go back to teaching and focus primarily on lecturing. And my hope for him is that whatever he's doing, I hope it brings him as much fulfillment as treating patients has.

It's wild to think he RETURNED to treating patients about 18 years ago, and of that 18 years, I have been seeing him 4x a year for 14 of those 18, so I've been there for the long haul as it were. And it was a good run. And he taught me a shitload about not just the assortment of things I need to stay on top of, but he's also taught me a lot about MYSELF.  

I plan on getting a birthday card and sending that off to him, as his day is coming up; and I plan on getting two lovely thank you cards and send them to his secretary and his clinician--both of whom I will miss interacting with them. Great, super sweet, friendly and professional women, both of whom I hope end up on their feet. 18 years is a long time, and this change will break up that little, happy, work place "family." 

Nothing lasts forever. 
Change can be a good thing for all involved.

It's still sad and a bit of an unexpected shock.