NEWS: Monitoring thyroid hormone therapy is necessary

Original article HERE

Monitoring Thyroid Hormone Therapy Is Necessary - Marilyn Linton

More than a century ago, a 46-year-old woman's life was saved when her dangerously underactive thyroid was treated with dried sheep's thyroid. Since then, thyroid hormone therapy has become the gold standard of treatment for hypothyroidism (an underactive thyroid gland), though the hormone, called levothyroxine, no longer comes from the minced up glands of animals.

In fact, levothyroxine (produced in a lab) is among the top five prescription drugs sold in North America. Over nine million prescriptions for Synthroid, one brand of levothyroxine, were written in Canada in 2005, making it the second top-selling drug next to cholesterol-lowering Lipitor.

These drugs, also known as L-thyroxine or T4, provide for the thyroid hormone if your thyroid gland is unable to make enough. And there are lots of underactive thyroids out there, because hypothyroidism affects three percent of the world. M. Sara Rosenthal, a thyroid expert, writes in The Thyroid Sourcebook that roughly four to seven percent of people over the age of 60 are hypothyroid.

An aging society that's increasingly hypothyroid explains, in part, the zillions of pills taken annually; but many younger people also take it to address fatigue, cold intolerance, depression and a host of other everyday maladies. There's also the view that thyroid supplements work as a weight management tool. So no wonder that this medication has shifted in the public's mind from life-saving medicine to life-enhancing therapy.

Now, a recently published study underlines the fact that thyroid supplements are potent medicines that should be monitored annually by a doctor and respected by those who take it. In the study, conducted by a team of researchers from Toronto, elderly people who were taking medium to high doses of levothyroxine were found to have had two and a half to three times greater chance of suffering from a fracture than those who were taking a lower dose.

Eighty-eight percent of the people studied were women, says Dr. Lorraine Lipscombe, research scientist at the Women's College Hospital Research Institute. "We wanted to see if there was an effect of levothyroxine treatment on the risk of fracture on persons over the age of 70. Results of our study suggest that maybe these people were getting too much thyroid because their fracture risk was higher with these higher doses."

Of the 213,511 people studied, a total of 22,236 (10.4 percent) of people experienced at least one fracture during the study period which was between 2002 and 2007. The study was done using population health data bases in Ontario; hospital records were used to identify fractures.

The majority of people are diagnosed with hypothyroidism in middle age, she explains. "While initially they get monitored to try to get the right dose, once the right dose is determined, often times they stay on the same dose for years." As people age, their thyroxine requirements fall but their doses often remain unchanged into old age. "We are beginning to realize that the dose that was appropriate for them in middle age is no longer appropriate for them as they enter older age. People who are on thyroxine should go to the doctor and make sure that they have had a recent blood test to see if they're on the right dose."

Regular dose monitoring may not be done for a variety of reasons: People who have been on one dosage for years and who feel good on it may assume that the dosage is still appropriate; doctors themselves may overlook their patients' need for a blood test (which is necessary to confirm thyroid hormone levels), particularly when older patients present with other problems that need tending to.

Experts report that too much thyroxine speeds up the body's metabolism and thins the bones, but it isn't just the fractures that are worrisome. Too much of this hormone increases the risk for serious heart arrythmias, and muscle weakness. "Our job with this study was to raise awareness that thyroid hormone levels need monitoring. We estimate that about 20% of seniors are taking levothyroxine, so this has a big impact."

New guidelines?

The study, published in the British Medical Journal, suggests that the ideal dose of thyroid drugs should take the age of the patient into consideration. In Canada, one levothyroxine brand is called Synthroid; another is Eltroxin. If you're taking either, do not stop them, but check with your doctor at your next appointment about whether your dose needs to be changed.

The butterfly gland

The thyroid, a butterfly shaped gland situated at the base of the throat, naturally secretes a hormone that is responsible for regulating the metabolism rate of the body. Hypothyroidism, the lack of thyroid hormone, is treated with levothyroxine.

The Thyroid Sourcebook

M. Sara Rosenthal's excellent book tells you everything you need to know about the thyroid, its diseases and disorders. The thyroid cancer survivor and consumer health specialist also covers the latest treatment options and complementary therapies, the best tests, and how to spot bogus websites in the thyroid e-health movement.

The Thyroid Sourcebook - M. Sara Rosenthal Ph.D

The Thyroid Sourcebook For Women - M Sara Rosenthal Ph.D

The Birds & The Bees...and Aliens.

Up early to go to the doctors this morning. But no matter how early we get there, we're never first...do the locals camp out there overnight, seriously? Might go the night before in the camper van myself next time!

Dragged the husband along with me this time. He's got an alien growing on his foot, and he's been whingeing about it for ages, but then refusing to go to the doctor's about it...so I tricked him, by saying that I hoped to discuss our brand-new baby-making future with her, and wanted him there for the discussion. Sneaky wife!

Turns out its not an alien after all...its a ganglion (AKA Bible Bumps)...and that means I can legitimately thump him with heavy books, even the doctor said so**. But in the meantime, in case my domestic abuse with heavy books doesn't work, she's going to refer him to the local hospital to have it removed under local anaesthetic.
(**Apparently, the old-fashioned treatment for ganglions was to hit them with heavy books, most commonly Bibles!)

We did discuss our future of baby-making, so I didn't totally lie to him. We have agreed that I will stop my current blood pressure meds, Omesar Plus. As they are *NOT* suitable for use during conception, pregnancy etc. My blood pressure this morning was 145/67, which she was pleased with. I am to start taking my blood pressure regularly at home again, now that I am stopping the meds (I let that habit slip a little ) and if it does start to rise again, she can prescribe me another pregnancy-friendly BP med instead. We postulated that since my thyroid levels were now good, as well as stable...that any lingering blood pressure issues are now solely down to my weight/lifestyle. So if it stays down, even after I have stopped my HBP meds, then I will be doubly happy.
We also discussed my age, and how that was a factor, time was against me etc etc. And whilst she would normally advise couples to go off, have fun, and come back if nothing has happened after a year...given my age, and pre-existing health issues, she has advised that we come back after 6 months instead if there is no 'stork' news, so we can start looking for, and dealing with, any problems sooner.

Obviously, I need to start taking the pre-pregnancy vitamins again - I stopped them after my Difene scare earlier in the year - I cut out everything pill-wise that was non-essential for a while, and then I didn't get back into the habit of taking them again. I will be taking Pregnacare Plus

On the subject of Difene - she has prescribed me an alternative pain-killer, just for those really bad (thankfully rare) days when paracetamol just isn't cutting it on those period pains. Fingers crossed this one doesn't have me heading to hospital in an ambulance again!

Almost forgot...shameful since this IS predominantly a thyroid blog...she also took routine thyroid bloods for testing. Been 3 months since my last set, and if these are OK, which I'm confident they will be, we'll go to 6-monthly intervals.

Until next time...I'm off to weigh some books, and pick out the heaviest ones!

Cowboys, handbags & my new Endo

I seemed to be waiting an inordinately long time for my pre-appointment visit with the nurses (the dreaded weighing chair), and so I took some time for people watching in the over-crowded waiting room. Over-crowded because in the three weeks since I was last there, the contractors have moved in, blocked off the main corridor access for the out-patients department, and put up a wall where once there was ample seating, and thus reduced the waiting area in the busiest out-patient departments to less than half the space...chaos, and so unrecognisable that I walked straight through the place, after taking a double look in confusion, only to find myself in OP2, wondering how I'd got there without walking through OP1.

The first thing I noticed were all the new faces with ID badges, shiny new interns bustling about. Some over-brimming with confidence, and looking like they'd settled right in....others looking like they still didn't know where they where, why they were there or what was happening....I reminded myself to ask specifically for the senior registrar...just in case I was unfortunate enough to be allocated to one of the latter. Another thing that struck me about the female interns was that they all seemed to be surgically attached to their handbags...every time they came out of the consultation room, to go to the nurses station in order to collect the next patient's file, the handbag was there, hanging off the shoulder. Is this some sub-conscious comfort thing among young female interns....or is there some major crime spree going around the hospital? If the thief was foolish enough to steal my bag he'd be sorely disappointed to find a wallet packed full of old receipts, instead of money; a microchip scanner for dogs; and very old mobile phone, due to make its debut on the Antiques Roadshow sometime soon.

One other guy who drew my attention was just wearing the most fantastic outfit. He had a very well-worn pair of tan Cuban heels, boot-cut denims and checked shirt. All topped off with a beautifully cut green wool jacket, a beautifully ornate pocket-watch & chain and the obligatory stetson. When he informed his wife he was going outside for some fresh air, I'm fairly sure he was actually going to check their horses, no doubt tied to a hitching post, out there in the car park somewhere. Wonderfully eccentric, and he pulled it off really well, you couldn't help admire the care that had gone into putting it all together. Really wish I'd had the courage to strike up a conversation with him and his wife, as I'm sure they'd have been just as interesting as their clothing suggested. She had the boot-cut jeans, checked shirt and a neckerchief, and even if they'd sat opposite ends of the waiting room from each other you couldn't help but pair them up.

After an hour and half of not hearing the nurses call my name, I tapped one on the shoulder. "I promise you this isn't a hurry up, as I can see how busy you guys are, but I came in at 2.15pm, and you guys are usually very efficient at calling patients in the the pre-appt weigh-in, so I'm just wondering if my file got missed?" She apologised and went to see where my file could be, and immediately came back, blushing with embarrassment. She had indeed, by mistake put my file on the wrong pile, and they had all totally missed it. The led me straight to the dreaded weighing chair, and we're graceful enough to stay silent as they noted the increase in the last few weeks....I really must get off this *I'm still recovering* trick, and cop on to stopping the slide before it gets away from me!
But, if nothing else, it shows that it pays to know how the system works...or I might well have found myself sitting for many more hours before anyone noticed my misplaced patient file.

The new registrar, who called me within 10 minutes of my visit to the nurses room, seems like a nice guy, and I think we can work well together. He was highly recommended by the nurses, and they know me well enough by now to tell me the truth.
He did initially start off by explaining the bog-standard basics of how the thyroid works, what it does, about TSH, the pituitary gland etc...I let him continue for a minute or two, and when I started finishing sentences for him he laughed, and said "you obviously know all of this already". I replied that whilst I wasn't a doctor, my thyroid had pretty much consumed my life for the past few years, in both literature, education & research, as well as the hard-to-ignore physical symptoms. He seemed genuinely pleased to hear this.
I guess he has to cover all the bases when he sees a patient for the first time, so fair play to him for explaining things in a way that even the most confused patient could follow. Although he was preaching to the converted, I'm delighted that he went to the effort.

He was really pleased with my latest blood results, as indeed he should have been, and when I tentatively suggested that the TSH of 1.1 was pretty much perfect he drew circles around my results, on the page, and said that my current results are exactly what we need to aim for, and then strive to maintain...all in all, so far so good.

He asserted that as far as my height, weight, build etc were concerned he reckoned that my current dose of 150mcg was the right dose to stay on, but obviously regular blood tests, certainly in the early days post-op, would quickly pickup any signs that a dose change may be needed. And also that if I lost significant weight in the future, my dose would likely be reduced (another big positive for losing weight!)

I mentioned the occasional dizzy spells, which are getting less regular, and he said alas that was indeed down to the Eltroxin...but as long as they were only every now and then, there was no need to investigate further. However, if they did escalate, I should go straight to my GP and get it checked out. He explained that in a normal person, with a correctly functioning thyroid, the thyroid levels would naturally rise and fall throughout any 24 hour period, and now that the actions of my thyroid were being replaced wholly by medication, there was no way to naturally mimic the daily peaks and troughs of T4/FT4 demand, only to judge how much I'd need and hope it was distributed as needed...and that is why the occasional dizzy spell is experienced.

And on the same subject, I brought up the suggestion of taking my Eltroxin at night, before I go to bed, instead of messing around in the morning, and having to stay food & drink free for up to an hour after taking my meds...and he categorically said that no, I really should take them in the morning...as one of the peak demand times for T4/FT4 was at the beginning of the day, when you get up and do stuff and need to feel well enough to be active. And by taking the Eltroxin at night, I risked insomnia and sleeplessness from having the full dose of T4 in my system, and then also having it depleted somewhat by the morning when I needed it most. If what he's saying is true, then it makes sense. So for now, until I can find some compelling research articles that say otherwise, I will dutifully follow his instructions, and continue to think about ways of doing it that I will find sustainable for the rest of my life.

We discussed my desire to start a family, and he said that what he would want to see are three consistently good blood test results. My first set of bloods, post-op were 'OK', my latest set were 'Perfect'. If the next set were also 'Perfect' we can discuss it further, but he would prefer to wait for a third 'Perfect' set before giving us a definite green light. Due to the fact that we *will* have further thyroid level complications during pregnancy, so he would prefer us to be as close to perfect as possible, which should make things easier to control when they start going bad again.

And once again, it seems our wedding anniversary weekend will conclude with a visit to hospital.
Regular readers might remember that we got married in a local hospital, as a quirk of our county's civil registration procedure.
Last year we spent the morning of our first wedding anniversary, with me having a CT Scan done - gosh was that only a year ago? It seems that SO much has happened as a result of that CT Scan and the results it yielded. Here I am 11 months later, without a thyroid gland and I feel like that was a lifetime ago.
Our second wedding anniversary will most likely be spent having a long weekend away in the camper van, touring some wild & beautiful part of Ireland, with no fixed agenda...but we'll have to hurry back on the Tuesday, in time for my next Endo appointment on the 31st August. Hospitals and wedding anniversaries really *are* starting to become intrinsically linked, but as long as they are routine appointments, and not visits to A &E, then I'm happy to continue that trend!

*1* is the magic number

Forget *3*, in thyroid-land *1* is the magic number!

For those of us doing battle with our thyroid glands, or in my case now sans thyroid gland, juggling medication levels to emulate our thyroid function, 1 is the magic number. Not all doctors and Endo are aware of this purported holy grail of TSH readings, but so much research and information out there in the real world points to the fact that a TSH of 1 (or as close as dammit) is desirable for optimum well-being.

I've only been near the magic 1 twice since I my first official thyroid blood panel, taken in 2004. The first one was back in July of 2009, with a TSH of 0.65...alas that was a very short lived 'blip', in June '09 my TSH had come back as 4.64, and by August '09 it had dropped to 0.01, firmly back in hyper-land. I can only assume, that somewhere between September '08 and January '09 it also crossed the magic 1.0 threshold, albeit for a day or so, as it swung from 0.03 up to 18.3, well into hypo-land. and most recently, the last time was a month before my thyroidectomy, when the bloods taken on 12th April '10 came back with a TSH of 1.36.

But yesterday, I came back from my GP's surgery staring at a copy of my latest lab results, with a magical 1.1 in the TSH column. FT4 wasn't so bad either at 20.7, just 0.6 above normal ranges...and as explained to me by the kind folks on the Thyroid-Disease Support Forum it was suggested that since I no longer have a thyroid gland at all, a slightly high FT4 is OK, if not desirable. "Barbara" on the T-DSF wrote "when you are on complete [thyroid] replacement you need more T4 because of poor peripheral conversion to T3 in your body tissues. A normal thyroid produces mainly T4 and it also produces a little T3 too but once your thyroid stops working, either by disease or removal, you need extra T4 to compensate."
As I understand it, form the crash course I'm currently undergoing regarding life without a thyroid gland, I need to be aiming for a TSH as close to 1 as possible, and FT4 slightly above range...and if this latest set of bloods are anything to go by, I'm there, right here, right now!

But...and there always has to be a but...only by subsequent blood tests, presumably scheduled within the next 2-4 weeks, will we know for sure if it is all levelling out and reaching some kind of 'perfect' thyroid equilibrium, indicating my bloods are spot on, and in turn, that my medication levels are perfect...or if my TSH will continue to drop (2 weeks ago it was 4.07 (indicating I'm possibly over-medicated) or indeed, bottom out and start to rise again(indicating that I'm under-medicated).

Still lots of hypO cramming to do before I see the NEW Endo on Tuesday, but I feel I'm just starting to get my head around how to lead a gland-less life, and will have some newly-learned armoury to take in with me to my appointment, just in time for the *all-switch* medical staff rotation that takes place in teaching hospitals across the land...

A few articles of interest, regarding 'optimum' TSH...

*Normal* TSH - An article on optimum TSH published by Thyroid Australia Limited

UK Guidelines for the Use of Thyroid Function Tests - go to page 25

TSH, Temperature... - An article by Dr Raymond Peat MA PhD

What is the Optimal TSH Level for Thyroid Patients? - An article by Mary Shomon

And finally, I love the idea of this, and look forward to giving it a go!

Yoga Can Help Thyroid Conditions - an article by Dear Thyroid, posted on Opposing Views


In other news....I would have posted this blog yesterday evening, but I got ghoulishly caught up in the media circus regarding Raoul Moat and the inevitably fatal end-game, and I ended up glued to Sky News until 4am...

"I Don't Know"

This morning hasn't gone well so far.

Knowing I was waking early this morning, my intentions for an early night last night were dashed when I found myself still messing around online after midnight...this is getting to be a real pattern with me, and I can't seem to break it. I can't get up in the mornings, and I can't seem to get to bed before 2am at night.

Undeterred I set my alarm an hour before I wanted to get up, so I could swallow my Eltroxin and go back to sleep...so far so good...but then I got tormented by the snooze setting on my alarm. And so my plans of waking serenely and enjoying coffee and breakfast before heading to the doctor for the next round of blood tests, was replaced by a mad panic of realising I was still in bed and needed to be heading out the door in less than 5 minutes...eeeek!

It never seems to go to plan, but the receptionists at the surgery are very discreet, and they almost never comment on my bed hair, or the toothpaste dribbled down my front, so I think I got away with it again.

But I was still firmly in sleep-land during my appointment...I didn't cop that my doctor only took one vial of blood this time, until it was too late, and I was already holding down the cotton wool on the recently violated vein, so she could put in the strip of sticky tape over it. Which means I'll *only* get my thyroid panel done this time...with not a clue of any of my other blood indicators.

I also completely forgot to mention the dizzy spells I've been getting...and when she asked me how I was feeling all I could muster was "I don't know"...which is of absolutely no use to man nor beast! I had it all prepared...what I wanted to discuss with her, the dizziness, the neck stiffness, the *up* days, where I'm raring to go on everything and fit to burst with ideas and activities, and the *down* days, where I couldn't even tell you my name because my head is so foggy....and all I managed to say was "I don't know"....very profound!

I did remember to mention the stitch/infection issue on my scar, which is looking heaps better since I stopped using the Bio Oil, and instead bathed it in Savlon Antiseptic Wound Wash Spray twice a day. And she did have a little dig about with the piece of stitch still evident, but stated there wasn't enough there for her to get hold of and do something with it. She said the dissolving stitches normally take around 4 weeks to dissolve, and if it was still there in 2 weeks time then she would investigate it further for me...I have a horrible feeling that may well involve a dab of local anaesthetic and a scalpel, but I didn't ask. She said to continue with the Savlon Spray if it flared up again...and to stay away from the Bio Oil until she said it was OK to try it again.

Then, to add insult to injury, when I went to pay my fees at reception I realised I had no cash. and there was no cheque book in my handbag. I sheepishly said I'd nip into the nearby village and get some cash out...to find the only shop in the village with a cash machine had it removed 2 weeks ago...so back to the surgery, with an even more sheepish "I'll pop the money in the post"...

Am I still over-exhausted from the stupidly busy, but extremely fun weekend I've just had, or am I in thyroid brain fog hell....you have until Friday to guess, because that's when I'll get today's test results back, and all with be revealed, ha!

My Head Is Spinning

"I don't know what's going on right now. I'm a little foggy, a little dizzy. It's crazy. Crazy!" Robbie Ginepri, American Tennis Player

I know exactly how he feels! I have been getting dizzy spells the last few days, just little ones...but they're becoming more frequent.

My pharmacist warned me about dizzy spells and feeling woozy when I first picked up my script for Eltroxin. She said if I felt a bit weird to head to my GP and get my blood pressure checked, just in case. She claimed that Eltroxin could sometimes cause your blood pressure to plummet, as your body adjusted to it etc.

So I checked my BP at home just now, after my most recent dizzy spell, and its fine (and yes, I have checked the accuracy of my own machine against my doctor's sphygmomanometer). My BP came in at 123/87....at the high end of normal, but not quite into the high-normal range, if that makes sense...but definitely not low, which is what the pharmacist warned me of.

Looking forward to getting my blood tests done again next week, was just discussing with hubby that I *think* I might be going slightly hyper....just a hunch. But the last couple of days I can't sit still, I want to be doing stuff constantly...real ants-in-your-pants, fidgety frustration and anxiousness (without being quite full blown anxiety) to get up and go...do stuff. I'm going to bed stupid late (around 2am) and lying there with my head buzzing to bursting point with thoughts and ideas, because I'm not tired, then up early in the morning raring to go, but with nothing to do, and getting frustrated with that...or with so much to do, but not enough cognitive organisation to get stuck into anything, so I don't know where to start!
I also can't keep a thought in my head for more than 30 seconds, and I imagine trying to hold a sensible conversation with me right now is a total nightmare, as I keep jumping from subject to subject, with no logical train of thought....just blurting things out as they come into my head, because if I don't I'll forget what I was thinking about.

A stitch in time...

...but how much time? How long does it take for dissolving stitches to dissolve?

At either end of my scar I can just about feel what feels like a tiny piece of fishing line. Now I'm sure my surgeon didn't use fishing line, he assured me he'd used dissolving stitches, both internally (obviously!) and externally...and that I could just ignore them, they'll go in time....but how much time.

Hubby kept insisting I was imagining it, we both stared and peered at my scar, but couldn't see anything...but if you brush your finger gently across the scar you can definitely feel the stub end of the aforementioned article, that I'll just call fishing line, one bit at each end of the scar.

So how long until they disappear?

Back to my GP next week for another pre-Endo blood draw, so if they are still in evidence then I'll get her to investigate.

I'm having a mixed response to the Bio Oil. I will of course keep going with it, and I hope that in a few months time I will be absolutely singing its praises to the highest...but my observations for now are both good and bad.

On the one hand, it seems to make the scar sore immediately after I apply it...the soreness is only temporary, and not all *that* sore if I'm honest, but it definitely results in soreness where there was no soreness prior to application. Is this just because the scar is getting direct physical attention for the first time in 3 weeks? Or is the evidence of some possible left-over stitches a sign that I shouldn't be using the oil yet, ie the site is not totally sealed yet?
But on a more positive note, it seems the gentle massage of the area, during application of the oil, gives instant results in improved neck mobility. I find the scar gets tight, and my neck gets stiff, both overnight and as the day wears on, and yet as soon as I've given it some gentle attention with the Bio Oil, the scar feels much less tight and I can turn my neck to the left and right with a lot more ease.

In other news...I finally got the Wii Fit out again, and had an enjoyable 30 minute session on it this morning. I know I mentioned starting again with it a couple of weeks ago, but when the crunch came down I just didn't feel up to it. But I was delighted to find a lot of my regular exercises weren't nearly as difficult or painful as I expected them to be. If anything, I could do most stuff, but obviously took it easier on some of the games. I struggled with anything that involved holding my arms above my head, that really seems to pull on my neck, and some of the more obscure yoga stretches weren't achievable because I was afraid of straining my neck. However I still had a satisfactory session, and worked up a good sweat!

Driving Miss Stiffneck

I drove out late this afternoon to collect my blood test results.

This is the first time I've driven since the op...and in hindsight, it was perhaps a little too soon. I still have very little neck mobility, so checking to the left & right at junctions and roundabouts was interesting to say the least. And because I drive ancient old German cars, with no power steering or other modern nonsense, sharp corners and turns were harder work than my neck & shoulders would like them to have been. I have a feeling I'm going to pay for my precocious driving adventures later this evening, and possibly tomorrow too...so, in anticipation of that, whilst I was out I stocked up on extra painkillers too ha ha!

I think I'd have just ploughed right through the middle if I'd had to deal with this set of roundabouts today...



With regards to my blood tests, I was little dismayed to see that I'm slightly hypO. I say dismayed, but lets be realistic...I guess perfect bloods, and the perfect Eltroxin dose, immediately after my thyroidectomy was impossibly optimistic.
My TSH came in at 4.07 (range 0.15-3.2), and my Free T4 came in at 21.8 (range 9.9-20.1). Only marginally hypo really, but with results like that, the labs obviously didn't bother testing the FT3 and T3.
I'm certainly not experiencing any major hypo symptoms, certainly nothing like I've experienced in the past when I've been hypo before...which I'm glad of, because those few months, back in 2009 were truly a living hell!

My Urea levels are above normal for the 2nd month in a row. Definitely something to mention to my Endo next Tuesday. This month they were 8.0 (range 2.5-6.7) and last month they were at 7.1. For the previous 2 years they have consistently been between 4.0 and 6.0 so definitely something I'd like to investigate further. It may just be because I've rediscovered my love for filter coffee, and I'm not being as disciplined regarding my water intake these days.

Delighted to see that my WBC count is higher this month, higher than they've been since almost forever. Up to 7.8 (range 3.9-11.1) from last month's 6.1 my WBC has never been out of lab ranges, but there has been a definite downward trend since I started taking the Carbimazole, something I've been keeping an eye on even if neither my doctor nor my Endo have been too worried about it when I've drawn it to their attention. And I hope that is because I'm no longer taking Carbimazole, a side effect of which for some people is lower WBC counts.

I'm meant to be heading off camping with some friends tomorrow night, but I really am going to have to wait and see how much of a fuss my neck makes after driving today...I hate to admit it, but I may just be trying to do too much too soon :(

Painkillers, Bloodtests & Cinnamon Bagels

Today I'm sore again. My neck / throat hasn't physically hurt for a good while. Its been uncomfortable, its felt awkward, it's nearly always stiff, it generally feels like someone has a good tight, choke-hold around it....but it hasn't been sore. Yet today it is hard to swallow, no, painful to swallow...and ironically, swallowing the painkillers this morning was the hardest thing to do. I almost gave up on lunch completely, and was tempted to make a cup-a-soup instead. Its not sore in a 'sore throat' flu way, but sore as in it felt like I was trying to push food or liquids down past a very solid (and bruised) brick...and occasional stabbing pains in my chin area, and in the left-side of my neck.

I don't know why today should be any different, why I have this throat / neck pain. I have a stupid little theory that my painkillers are working so hard on my period pains - which usually cripple me, to the point of lying on the floor flailing & wailing like I'm in labour, and which are currently barely even making background noise in the pain-stakes - that they aren't working on my neck pain. Highly improbable, but its an explanation which my head is happy to settle with.

Hubby and I headed off to my Doctor this morning (I'm still not able to drive) to get my blood tests done, in anticipation of my Endo appointment next week. The first trip was a wasted effort as she had swapped her Nursing Home Visit from Wednesday to Tuesday, so we went home for an hour or two. I made a Chocolate Biscuit Cake (diet is back on the shelf for another week ), whilst hubby made the most of his morning off from work, and caught up on Top Gear re-runs on the Dave channel. We went back after 11.30 am and it was 2nd time lucky. I explained about today's pain, and how I hadn't had actual pain in my neck since I left hospital, but she reminded me that after a thyroidectomy, my oesophagus was likely to be sore for a surprisingly long time. And that it would most probably continue to remind me occasionally that I wasn't as healed as I thought I was.

I also surprised myself by explaining to her that whilst in general I feel OK, I also feel like I'm still 'treading water', only now instead of waiting for my op, and thus in my head for the rest of my life to begin, I'm now sitting around waiting to start feeling hypO. I was just sitting there in the waiting room, thinking to myself how cold it felt. Then I started looking at the other people sitting there, and wondering if they felt a little cold too, or if it was just me. I almost collapsed with relief when one lady piped up to her neighbour and commented on how cold the waiting room was, given the sunny weather outside! Phew, not just me then! Until that moment I don't think I'd even confessed to myself how much I have been possibly over-analysing every little feeling and trying to fit them into the well-known list of classic hypO symptoms.

We also discussed the info I'd discovered on possibly interactions between Xenical and Levothyroxine / Eltroxin. And she reassured me that she had a few thyroid patients successfully combining Eltroxin and Xenical, showing good weight loss, with no significant impact on the efficacy of the Eltroxin. So once the Chocolate Biscuit Cake is safely eaten up and out of my fridge, I'll consider digging out the magic blue pills again. She reassured me that they would be monitoring my thyroid levels *very* closely over the next few months, and that any dose changes needed, would be picked up very quickly. So now was as good a time as ever to start back on the Xenical, if I wanted to do so. But she did also say that if I didn't feel ready to knuckle down on the diet again, and wanted more recovery time, to make my own judgement as to when to start back on the diet pills again. She knows, as well as any of us girls do, that sometimes, when you're feeling low, or in pain, or just a little sorry for yourself...chocolate *IS* the only remedy! :)
(And chocolate is most certainly *NOT* an option when you're taking Xenical!)

In other news...is there a world shortage of Cinnamon Bagels, or is it just localised to my town? I'm hooked on them...but my long suffering husband took me from shop to shop searching for them, and in the end I had to settle for 'fruit loaf' instead....and there is just NO comparison.

Levothyroxine & Xenical...

...possibly not the best of friends?

After breaking my diet for a few weeks, whilst I had my Total Thyroidectomy, I decided this weekend that I needed to get a handle on my blimp-ness again.

I had planned to drag out the Wii Fit Plus again, and reacquaint myself with the magic blue pills. But something I think I must have read ages ago about hypothyroidism & Xenical was nagging at me from the back of my mind, where I guess I filed the info at the time, so I did a quick Google...and hey presto!

Drug Interactions with Xenical

Drug interactions can occur if you take Xenical with diabetes medications, cyclosporine, or warfarin. When taken together, these interactions can affect the level of medication in your blood and can change the effectiveness of the medication. Tell your healthcare provider about your weight loss program so that you can avoid any drug interaction with Xenical. Your healthcare provider can adjust your dosage and monitor you closely.

Introducing Xenical Drug Interaction

Some of the medications that may interact with Xenical are listed below. Xenical (orlistat can potentially interact with a few other medications. These medicines include the following:

* Diabetes medications

* Cyclosporine (Neoral, Sandimmune, Gengraf)

* Amiodarone (Cordarone)

* Thyroid medications, which include the following:

o Levothyroxine (Unithroid, Levoxyl, Synthroid)

o Thyroid (Nature-Throid, Armour Thyroid)

Thyroid Medications

People who have taken thyroid medications along with Xenical have experienced low thyroid function, better known as hypothyroidism. You should have your healthcare provider monitor your thyroid function while you are taking Xenical, because he or she may need to adjust the dosage of your thyroid medicine.

Moreover, it is highly recommended that you take Xenical and your thyroid medication four hours apart in order to avoid any drug interaction.

More, from the original article, here: Xenical Drug Interactions

And another article...

Xenical's Effect on an Underactive Thyroid

Contributor

By Merrill Gillaspy, eHow Contributing Writer

The diet drug Xenical has been shown to hamper the absorption of hypothyroid medication levothyroxine.

need to diet image by Kimberly Reinick from Fotolia.com

Xenical is a prescription diet medication. Its chemical name is orlistat. Described as a lipase inhibitor, Xenical acts to prevent the body's fat-dissolving enzymes from working, which ultimately interrupts fat absorption through the intestine. Xenical has a range of side effects and contraindications, not the least of which is possible problems for people who have underactive thyroids.

Significance

1. According to the website Netdoctor, Xenical has been developed to act on two key enzymes of the digestive system: gastric and pancreatic lipases. These lipases break down fat molecules in the digestive tract that would otherwise be too large to pass as nutrients from the intestinal wall into the bloodstream. Xenical prevents these lipases from acting on the fat molecules, which remain whole and exit the body as waste.

Function

2. Xenical is prescribed specifically for obese and overweight individuals. The manufacturer recommends its use for people who have a body mass index (BMI) of between 28 and 30 or more. The BMI is a measure of the amount of body fat based on height and weight. A normal BMI is between 18.5 and 24.9. These numbers represent kilograms per square meter.

Cautions

3. Xenical should be used with the utmost caution by people who have kidney disease, diabetes (insulin dose may need adjusting), epilepsy (absorption of antiepileptic drugs may be altered) and hypothyroidism--or underactive thyroid (hypothyroid medication, like levothyroxine, may become less efficacious). Also, contraceptive pills and fat-soluble vitamins, like A, D and E, might not get absorbed as effectively. Consult with your doctor about vitamin supplementation if you are taking Xenical.

Hypothyroidism

4. People on the hypothyroid drug levothyroxine have an underfunctioning thyroid. The thyroid is a gland--shaped like a bow tie--that's located at the front of your throat. The hormones it emits control your body's use of energy. With hypothyroidism comes a low emission of thyroid hormones and decreased energy, in addition to susceptibility to high cholesterol and heart attack. Levothyroxine is sometimes prescribed as a replacement for the hormone your thyroid naturally produces, but people on levothyroxine who seek prescription weight-loss remedies must use caution.

Levothyroxine

5. Xenical has been shown to hamper the absorption of levothyroxine. Consult your doctor if you have hypothyroidism and are taking medication, particularly if you take levothyroxine. Also, should you notice your levothyroxine becoming less effective with the use of Xenical, tell your doctor right away. Most people take levothyroxine for life, which means they must be very cognizant of all the other medications they might ingest. The manufacturer of levothyroxine specifically states that people should not use the drug to treat weight problems.

Read more: Xenical's Effect on an Underactive Thyroid | eHow.co.uk

So I guess I'll hold off on popping the magic blue pills until I've spoken to my GP on Tuesday....but I still plan to spank my Wii Fit Board tomorrow :-)

Some (very) Dark Thyroid Humour...

I guess I'll be avoiding Bok Choy from now on...time to re-read that list of goitrogenic foods!

Back away from the bok choy, ma'am
JoNel Aleccia writes:
Eating extra veggies is a good goal, but an 88-year-old Chinese woman took the quest too far, consuming enough raw bok choy to send herself into a life-threatening, thyroid-induced coma, doctors say.
The woman showed up at a New York emergency room last summer, complaining she couldn't walk or swallow. But the real trouble, according to a report in Wednesday's New England Journal of Medicine, was that she'd been chowing down on 2 to 3 pounds of bok choy every day for several months in hopes of controlling her diabetes.
For those unfamiliar with the vegetable also known as Chinese white cabbage, that's the equivalent of eating two or three large heads a day of the stiff, leafy stalks.

More here:
http://bodyodd.msnbc.msn.com/_news/2010/05/19/4380005-back-away-from-the-bok-choy-maam/from/toolbar

Eltroxin Hell & Chocolate Heaven

Of course it is inevitable that if you need something urgently from a pharmacy, it's a Sunday.
Or even better, in this instance, its Bank Holiday Weekend, so the pharmacies won't open until Tuesday.

I've noticed the same law applies with my dogs...if they fall ill, or have an accident, requiring veterinary attention it'll nearly always be on a Sunday...and trying to find a co-operative vet on a Sunday around here is even harder than finding an open pharmacist!

So this afternoon, having run out of Imodium, I found myself on the phone to the local Out-Of-Hours Doctor Service...begging the doctor to tell me that this diarrhoea hell will eventually stop, and asking the hours of the On-Duty pharmacist.

Of course, across the whole town, only one pharmacist is opening....for only one hour per day...and I've missed today's 60 minute prescription dash.

Which left me with no option, but to ride out the rest of today's Eltroxin side-effects, and, with the doctor's agreement, to delay taking my Eltroxin tomorrow until 12pm, when my husband can make a dash to the pharmacist to re-stock in Imodium, before he shuts his doors to the ill folks of this town again at 1pm.

The Out-Of-Hours Doctor assured me that my body would indeed eventually get used to my new dose of Eltroxin, and he promised it would be sooner rather than later...I hope he's right, because this is hell!

My husband and I have spent most of this evening driving around all the bigger supermarkets and petrol stations in the hopes that they may have a secret stock of Imodium, but to no avail. Seemingly I can buy all sorts of things off the shelf, but not something that will stop diarrhoea...and now why would that be? I'm quite sure I can do an awful lot more damage to myself with a couple of 12 packs of paracetamol, than I ever could with a boring pack of Imodium!

I'm now going to console myself by making up a huge Chocolate Biscuit Cake, in anticipation of Mum's birthday tomorrow. I just might have to cheer myself up by licking spoons, and licking the bowl while I'm doing it...and if the Eltroxin doesn't like it, well tough!

Bumpety-Bump

And I've already been 'bumped'

Going in this Sunday now, instead of Thursday, to be slashed either Monday or Friday, depending on whether I still need 'blocking' before the op.

Judging by my interpretation of this month's blood tests I'd say he'll do me on Monday though, as at the moment, the important ones are within 'normal' lab ranges...although my TSH is higher than I'd like it.

Should get more info tomorrow though, as I have an appointment with my Endocrinologist in the afternoon....who's meant to be working with my surgeon on sorting my levels prior to the operation.

Sunday suits me better anyway....Mum doesn't arrive off the ferry from the UK until Saturday, and it'll be nicer to see her and catch up on stuff before I go in...but please cross your fingers that I don't get 'bumped' again

News Article: Irish team to develop better thyroid test

Taken from Irish Health . com

Irish researchers are to develop a more accurate test for thyroid disorders.

The thyroid is a small gland located in the throat. It produces hormones that affect the body's metabolism and energy levels.

Thyroid disorders are common but because symptoms can appear gradually and are similar to the symptoms of other conditions, they are often misdiagnosed. A common thyroid disorder is hypothyroidism (underactive thyroid), the symptoms of which can include weight gain, a lack of energy, dry skin and constipation.

Now, researchers at the Biomedical Diagnostics Institute at Dublin City University and Cork-based company, Audit Diagnostics, are working together to produce a fast, low-cost test for thyroid disorders.

The project, ThyroQuant, is aiming to develop a ‘point-of-care' test, which will allow doctors to diagnose patients accurately in their surgery.

The project is being funded by a €350,000 grant from Enterprise Ireland.

I just hope they can make it 100% reliable and accurate, because anything that speeds up the blood testing & results procedure can only be a good thing...however, it won't address the issues that many, many thyroid disease sufferers have with regards to errors by their doctors (and occasionally endos) in the interpretation of tests, lab ranges and guidance statements.

All Systems Go!

A couple of days late with this weekly Xenical update...don't know where my time is going these days?

Warning, its a long one...grab a cuppa and make yourself comfy!

Anyway...1 pound down this week....which is OK. I'd like to have seen more, but I'll happily take any loss on my scales...looking back over my diet for the previous 7 days, and it seems OK, so I can only conclude its all down to my laziness regarding water intake, and not being as disciplined regarding exercise.

Monday was spent in hospital (routine appointment, not an emergency!)
First up was my dietitian who I see every 2 months (and can chat on the phone to at any time if I'm having a crisis). She weighed me in at 300lbs, whereas my scales weighed me that morning at 295lbs...which is OK...at least now I know the margin of error for my scales (hers are calibrated regularly!), and as I use mine weekly, and only get to sit on hers every 2 months, I will continue to use the figures on my own scales for my weigh-ins. Also, my weigh in at home was in my jim-jams...and in her office I was fully clothed...not 5lbs difference I'm sure, but still.

Then after my appointment with her, I then headed to the ENT department, for my appointment with the consultant surgeon who's doing my op. And had a very interesting session there...which involved a conference call, in my presence, with both my dietitian and my Endocrinologist...and the conclusion that they have now officially drawn is that I am, for definite, one of those 4%ers who actually gain weight whilst hyperthyroid, instead of more typically suffering dramatic weight loss, despite increased appetite.
So...they have decided to go ahead with the op now, regardless of how much I weigh...and the deadline for my pre-op consultation is 9 months (that's when I'll finally be put on the surgery waiting list - so fingers crossed could be on the operating table before march 2011...which is excellent news.
Not only because I will no longer feel like *such* a huge failure every time I go into hospital and get weighed by the nurses in the ENT & Endo departments...who do absolutely nothing to hide their disdain and tut loudly as they update my patient records each time.
And secondly, because for the last 18 months I feel like my life has been on hold waiting for a decision on my surgery...initially they were adamant they wouldn't do it until I was below 200lbs, and now they have conceded that it just needs to be done, sooner rather than later, regardless of my weight.
Until I have this op we have virtually no control over my thyroid function, and I'm not allowed to start a family...so although its only a pin-prick in the far distance, I do finally feel there is some light at the end of the tunnel...rather than treading water, and spending another couple of years trying to shift weight that won't move, whilst the ticking of my body clock gets louder and louder until it finally gives up and I'm too old to realistically start a family.
I am so delighted to have finally had a definite decision from my Endo regarding my status as one of the rare 4%ers - its something he has mentioned in the past, but previously refused to confirm it for definite. But it really does seem like the more I try and tickle my metabolism into working for me rather than against me, the more my thyroid fights back and suppresses my metabolism even more.

However, despite the relief of being recognised as a 4%er it doesn't let me off the hook...I still have to keep going, popping the blue pills, and watching my diet like a hawk...it just means my journey will be more difficult...and still the pressure is on to drop the weight, because despite the fact that they are now going ahead with my operation, regardless of my weight, I do also recognise that the heavier I am the harder it is for the anaesthetist, and the higher the risk for me....so it is in *my* own interests to get as much weight off as I can, and to get as 'heart-fit' as I can, before the anaesthetist comes at me with his cocktail of drugs...

I'm trying to walk every day (not just the daily dawdle with the dogs - but a proper, get puffing walk out)...but the Irish weather is so unpredictable its just not always possible.
I'm also trying to cycle more...in fact after my hospital appointments on Monday I drove down to the Shannon, and cycled for about an hour down the river path...felt great afterwards, really chuffed with myself! But cycling locally is reserved strictly for the brave, our local lanes are populated with speeding local lads in their rice-racers, of half blind monks from the local monastery who probably don't have driving licences but who are generally ignored by the local Gardai...despite going out decked in all the hi-viz gear I can find, and looking like some safety fanatic I've had my pedals clipped a couple of times in the last few weeks...so am now limiting my cycling to when I have the time to drive out and find a properly designated cycling trail off the road...or when I'm out bikejoring with my dogs.
So, yesterday I purchased a Nintendo Wii and Wii Fit Plus....I collect it tomorrow...and I just hope I'll be disciplined enough to do it daily.
Would welcome comments from any of you guys regarding the use of Wii Fit to help keep you fit and get the weight off...have absolutely no idea what to expect, but both my GP and my Dietitian have recommended it.

I also really need to get on top of my water intake though, I truly feel that is the key!

Oh, and as of Monday, I'm 10lbs down from my start weight of 305lbs...so that's the first part of my personal 10 x 10 in 2010 Mission done! Yay!!!

Blimey....that was a long post...almost a stream of consciousness spewing from my keyboard! If you've got this far, thank you x

Low BP...eek!

Checked my blood pressure not long after I posted earlier, as I was feeling really, really crappy and it came in at a worryingly low 113/55
Will keep an eye on that for the next few days...due to go into my GP for blood tests next Monday, and hopefully I won't have to go in beforehand!

I'm on medication for High Blood Pressure (Hypertension)...namely Omesar Plus...and it would be nice not to have to take them anymore, but I'm not holding out much hope...I think it was just one of those blips.

Endo takes my Goitre seriously!

When I was getting my bloods done the other day, in preparation for today's Endo appointment, I mentioned to my doctor that nobody at the hospital had been too concerned, or even interested in my goitre, no matter how often I mentioned it. I also showed her how much the right hand side had swollen up in recent weeks. She laughed and said "one look at that, and they'll be *VERY* interested this time, trust me!"

She wasn't wrong.

Once again, I was given a consultation with another fresh-faced young intern, but I didn't stay with him for long. One look at my goitre sent him scurrying for the Consultant Endo, and the rest of my appointment was with the boss himself.

He has decided to refer me for a CT Scan to check out the goitre, and also to an ENT consultant...just to make sure they have that covered. He mentioned the possibility thyroid surgery again, but also reminded me of the RAI option - essentially the decision is mine, I just need to do my homework and make the decision, if it comes down to it, but in the meantime it was worth setting the wheels in motion in case I decide to opt for surgery. I guess the goitre is what is worrying them, more than than my malfunctioning thyroid. He reassured me that it all still could come under control with the meds, and all this is purely speculative, but bearing in mind waiting lists for referrals etc we may as well go ahead and make a start.

My bloods are still out, my TSH is too high, and my Free T4 is too low - indicating that I'm very firmly in the Hypo camp right now. So we've dropped my Carbimazole from 30mg/day to 15mg/day.

RAI or Thyroidectomy?

Hoping this remains a hypothetical question for me, but I'm curious to hear other folks opinions on it...

Its becoming more and more clear that my thyroid gland is becoming more and more unstable. The latest set of bloods have me very hypO, even more than I was a couple of months back.
TSH is 18.3 range 0.15-3.2
my FT4 is apparently "below absolute low"...which is interesting, surely the lab should be able to detect it somehow, no matter how low it has dipped.

I've had noticeable goitre on the left side of my neck for years, with nothing to show on the right hand side. But, suddenly, in the space of 7-10 days the right hand side has now swollen to larger than the left, and is incredibly uncomfortable...breathing, swallowing, neck movement, all compromised.
My neck looks like a bullfrog, and my voice is so hoarse I sound like bullfrog too!

Due to see my endo on the 19th of May, but my GP has advised me to think about the fact that my Endo will now very likely suggest either surgery to remove it completely or RAI treatment.
For the record, I'm 35, married, no kids, but would like to think about having children in the reasonably near future, if I can only get this thyroid to behave itself.

So, throwing this 'hopefully' hypothetical question out to blog-land...if you were given the choice of surgery to totally remove the thyroid gland, or RAI treatment which one would you go for, and don't forget to say why?

Thanks in advance

Back Once Again

Seems I disappeared for longer than intended.

We had a weekend away camping, and that was disrupted by an emaciated stray dog who entered my life the day before we were due to leave.

So I've been very busy looking after her (still ongoing - and looking like a long term project) and learning all about greyhounds and greyhound mixes and their specific care needs. (She's approximately half the weight she should be)

She's gained 1.36 kilos in weight already though so I'm pleased with her progress...if only she and I could participate in a little weight swap ha ha! I'd gladly donate all of my spare weight to undernourished dogs!

Still off the smokes, and still giving the scales slightly less to hold up each week, so there are two positives already.

My new meds seem to be OK. They cut my Carbimazole back down to 30mg, and I finally relented on my BP Meds Argument, and consented to starting on Centyl-K, a diuretic. I bought a cheapo blood pressure monitor from my local pharmacy, and I've certainly noticed my BP coming down a little, so hopefully my doctor will concur. Maybe I shouldn't have fought against BP meds for all this time after all...?

The walking has slipped though, and I'm cross with myself for letting that go...need a kick up the bum and the discipline to get out there every morning again!

What A Difference A Day Makes

...24 little hours....

So much to say, so little time.

First off, missed weighing on Thursday morning because I was rushing to get to a doctors' appointment...but I was delighted to hop on the scales Friday morning, straight out of bed, and note a 2lbs loss...yay me! That's 5 lbs since January 1st, without really trying...so this week I will drink more water, start a sensible walking plan, pay more attention to what I'm eating, and make some real effort. Roll on Thurs 5th February...

The doctor's appointment?...well, to get my latest blood test results back. Some good news, some bad news....the bad offsets the good, and makes me a little sad to be honest. The good news is that my liver function tests, which were previously way out (leading me to worry I'd over done things in my student days) were back in normal ranges (yay!), proving my doctor right when she said at the time it was mostly due to my thyroid levels, but that we'd look into them more closely in the future if they didn't settle after I'd started on the thyroid meds.
The bad news...I had some hormone tests done this time around because I've been having really sucky monthly cycles for the last while...mainly a fortnightly cycle instead of monthly, with horrendous 'flooding' to the point where I literally dare not leave the house, for up to 7 days at a time, unless I have packed a whole 'going out' bag, complete with several changes of clothing and mammoth supplies of sanitary supplies (TMI I know, sorry), and had knowledge of access to a bathroom at all times, at a moment's notice. Well apparently my oestradiol levels (I'm sure I learnt this is 'oestrogen' at school?) are low, which apparently explains the awful time I'm having right now...but we don't know why, so again, for now, we're lumping that into the 'thyroid' package. With no current treatment plan, unless it doesn't improve in the future...so, I'm still stuck on this ridiculous 14 day cycle with no hope forthcoming, and a running joke in this house is whether to volunteer for an elective hysterectomy....not something to joke about I know! But, this 14 day cycle is really driving me insane.

And the remaining bad news from my blood tests is that, the current dose of thyroid medication is working really well...so well in fact, that I've swung from firmly hypERthyroid, to firmly hypOthyroid....which explains a lot of (hopefully *all*) the nasty new symptoms I've been experiencing, some old symptoms are back with a vengeance, and some nasty new ones have reared their ugly heads. My doctor made me promise *not* to alter my medication levels until I've been to my next endocrinologist appointment (two weeks and counting!), but I'm finding it really depressing to take my medication every morning now, knowing that instead of making me feel better, they are actively making me worse....

Thank heavens for a really understanding and totally supportive hubby, who has seen me at my absolute worst (and my absolute best, I hasten to add) and knows that the short-temper and mood swings are currently beyond my control. And bless him for not making jokes about my dry, scaly 'lizard' hands right now...yes, another symptom, because I'm really suffering from sense-of-humour failure these days, and often taking previously-funny little comments way too personally. So thank you Blogger, for providing a supportive portal, where I can get all this crap off my mind, writing to people who understand and may or may not be going through the same thing, and for allowing me to give my husband a break from venting my problems to him.

Yesterday afternoon I went out to microchip 5 dogs (I'm a qualified microchipper, and volunteer for my local SPCA) and came home to find the river had burst its banks and we were flooded (again). Ho hum...nursed my car, through the flood, to some higher ground near the paddock, and went for a wade to assess the damage. It didn't come in the house, thank DoG, but it was a close run thing. And my 2 SPCA foster dogs were in their outdoor run, balancing on the last piece of dry land they could find. So, a quick trip indoors to re-arrange things with my own 5 dogs, and I brought those 2 outdoor boys indoors. A few grumbles, and the occasional bicker over beds, but the rest of the evening passed relatively un-eventfully...this house is *WAY* too small for 7 dogs indoors, especially when one of the dogs (my own) is a grumpy, possessive terrier, with small-dog Napoleon syndrome and an attitude problem. He wanted to spend the evening hanging off the throats of the in-comers...instead, he spent the evening confined to his crate, not ideal, but safer for everybody concerned, and meant we could all relax a little more in front of the TV for the evening, as the other 6 get on really well together. The 2 'outside' boys slept in the bathroom overnight, and I was delighted to find it clean as a whistle this morning, so I can hopefully tick off the 'house-trained' box on their adoption forms at least. The floods started to recede around 5am this morning, and I could flush the toilet for the first time in over 18 hours around mid-morning today, phew! The 'outside' boys are now back outside, with their wet bedding replaced with clean, dry bedding....and their kennel and dog-run now comprising of more dry land than water features so hopefully everybody is happy. My washing machine is currently running the gauntlet of getting some more dog bedding clean and ready. The rain hasn't stopped all day, and I'm expecting the river to rise again at some point (flash floods off the nearby mountain), so I don't want to be caught short with last night's wet dog bedding.

During the week, hubby and I made a pact to quit smoking. We set the quit-time as Saturday night (tonight!). He's been out and bought himself a pack of nicotine replacement patches, and I'm straightening my own head to go it alone with will-power. So tonight we smoke our last smokes. Tomorrow we plan to wake up and go smoke-free. In the past when one has decided to quit, the other hasn't.....so we've been yo-yo quitting for a long time now, and that doesn't work. We've both proved to ourselves that we can go without, but the temptation when the other partner is lighting up is just too much after a day or two...so tonight, we finish our packs, destroy and dispose of any remaining cigarettes in the house, and go to bed to face the new day. Fingers crossed it works this time, for good! The health benefits alone make this an incredibly sensible idea, but the other basic fact is that at the moment we just can't afford to keep going. We're compromising on our food shopping budget to buy cigarettes (and that is just STUPID!), we're raiding savings accounts, and last week, the ultimate embarrassment was purchasing a packet of cigarettes after breaking into my copper coin piggy bank, and laying out the money on the shop counter in 1cent and 2cent coins...that has got to be desperate, and I want some pride back!

The weather is just too bloody awful right now to be motivated about specifically going out walking, but I'm trying to make more effort in my daily chores to do them in a more active way to compensate. I stride out with the dogs around the fields, I don't move my car from place to place in town, instead I park more centrally, and walk from bank to shop, to chemist etc. I make myself do the stuff my thyroid tells me that I can't be bothered to do, and I'm getting stuck into house-cleaning with a frenzy of activity. As soon as the weather shows any sign of breaking (just stopping raining would be good enough!) I *will* get my walking boots on, and get the hell out there!

Aww, crap, this turned out to be a loooong entry....I really need to work on perfecting those short, snappy journal updates...thanks for reading this far, if you're still awake.