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...

News Article: New research indicates higher risk for miscarriage in pregnant women with high thyroid hormone level

Original Article: punchng . com

Pregnant women with thyroid function test results in the upper half of the normal range have an increased chance of miscarriage, even when they lack thyroid-harming antibodies, according to a new study. The results, which the authors say show the need to change screening practices for pregnant women, will be presented at The Endocrine Society‘s 92nd Annual Meeting, ENDO 2010, in San Diego on June 22 by Alex Stagnaro-Green, M.D., senior author and senior associate dean for education at The George Washington University School of Medicine and Health Sciences.


Past studies have reported an increased miscarriage rate in women with an underactive thyroid and in women with a positive thyroid peroxidase antibody test, indicating the presence of antibodies directed against the thyroid.


”This study is the first evidence demonstrating that the upper half of the accepted normal range on thyroid function tests is associated with miscarriage in antibody-negative women. This leads us to think that all pregnant women should be screened for thyroid function and any abnormalities treated,” said Dr. Stagnaro-Green.


Thyroid function is measured by the thyroid stimulating hormone (TSH) blood test, and anything above the upper limit is an underactive thyroid, called hypothyroidism. Since 2007, the recommended upper limit of the normal range of the TSH test for a pregnant woman has been 2.5 milli-international units per liter (mIU/L) in the first trimester and 3 mIU/L in the second and third trimesters. This recommendation was made by an Endocrine Society international guideline committee, of which Dr. Stagnaro-Green was a member. However, he said doctors have not universally accepted this guideline, and some use 4.5 or 5 mIU/L for an upper limit, the same as for nonpregnant women. Also, not every pregnant woman receives thyroid function screening.


To see if TSH on the high end of normal affects pregnancy outcomes, the researchers determined the pregnancy loss and preterm delivery rates of women who had TSH values between 2.5 and 5 mIU/L in their first trimester of pregnancy. They conducted the study at two community hospitals in Italy among pregnant outpatients who had a TSH level at or below 5 mIU/L during their first semester.


After excluding patients who had positive thyroid antibody tests, the investigators studied 4,123 women. They divided subjects into two groups based on TSH level (mIU/L): group A: below 2.5, excluding those who had an overactive thyroid, and group B: between 2.5 and 5.


There was no difference in the rate of preterm delivery between the two groups. However, the rate of miscarriage was significantly higher in group B (higher normal TSH) than group A (lower normal TSH): 6.1 percent versus 3.6 percent, respectively.


None of the antibody-negative women in the current study received thyroid hormone treatment. However, Dr. Stagnaro-Green said previous research shows that such treatment lowers the miscarriage rate in antibody-positive women.


[Emphasis in the article, added by me]


Since my thyroidectomy, starting a family has moved higher on my list of priorities. All the while I was hypER, and taking carbimazole, it was all but forbidden by every member of my medical care team. So articles like this are of increased interest for me, and hopefully of interest to others who may be in my position.


Interesting that the article specifically makes mention of the fact that there's still an increased risk, even for those who test within *normal* ranges...and hopefully provides further strength to the argument that many thyroid disease sufferers have with the doctors and endos, in that just being within 'normal' range is not necessarily good enough to be feeling well, and that the suggested target TSH level of 1 or below is becoming more and more important to achieve, and to be recognised by the medical profession in general.

Noooooooo !

Just back from my first Endo appointment since my thyroidectomy. Dragged my long-suffering husband along with me, as I didn't want to risk driving again, so soon after my weekend adventures.

The appointment went well. We've decided to stick with my current level of meds (150 mcg Eltroxin), his argument being that my FT4 is high at the moment, which should hopefully trigger my Pituitary to stop pumping out TSH. He also stated that this soon after the operation my whole system is still under stress, so we don't want to be chopping and changing the meds too hastily at this point, in other words give the dust a chance to settle, to allow us to see more clearly what is going on.

I asked him if I should be abstaining from taking my medication on the morning of future blood tests, or to just keep popping the pills as normal. He mumbled something about 'circadian' as if to himself, then declared that I should take my pills as normal (around 7.30-8.00am) and this would have no bearing on blood tests taken the same morning.

I also explained that I had learned from various sources, about taking the Eltroxin first thing in the morning and not eating or drinking anything for an hour afterwards (especially milk or coffee!). He agreed with this, and asked me how I was coping. He correctly assumed that this was the approach I was taking with the Eltroxin. I explained my morning ritual, of setting an alarm, popping the pills then going back to sleep for an hour...and sadly, he agreed that this was a good way of doing it. I was hoping he'd tell me some other miracle way of getting optimum results from taking these pills, without messing around with my sleep in the morning...but no such luck. maybe once we have my levels better I can slowly start to experiment....I don't want to f*ck around setting alarm clocks an hour before I want to wake for the rest of my life, nor do I want to sit around counting down the minutes to my first cup of coffee!

He asked me to make my next appointment in 3 weeks....yikes! If I have too many blood tests at 3 weekly intervals we're going to have to majorly cut down the food budget to afford them, but hopefully this won't last long, and I can get on to a more financially sustainable blood test interval soon.

And finally, as I headed to the door to make my next appointment with the receptionist, he dropped an absolute bombshell on me. He won't be there in 3 weeks time...in fact he won't be there again....he's transferred to another department!
Nooooooooooooooooooo....just when things were going so well, I really felt we were getting somewhere, and I found an endo who was a delight to work with, a genuinely nice guy, and who didn't treat me like a chart number, who always asked how I was feeling, regardless of the numbers....woe is me :-(

I can only hope that his replacement is even half as good. Watch this space...

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 :(

Out with the Old

My Post-Surgery appointment letters for both my Endo and my Surgeon turned up in the mail yesterday, I'm back to see them on the 22nd & 24th of this month respectively.

And so I've pencilled in this coming Tuesday with my husband to go and visit my GP, and get my bloods drawn. (I still can't drive after the op, so he needs to take me wherever I want to go)

And it occurred to me that this next set of blood tests signified the dawn of a new era for me....my first set of bloods sans thyroid gland...and so my blood tests slate is effectively wiped clean, and we're starting all over again.

So, just to allow me to mourn the passing of all my old lab tests, here, for one last time are my most up-to-date lab graphs...

[the FT4 range 'wobble' is where the labs changed their testing technique,
and thus the ranges changed]

Looking forward to making new graphs, with my new results, in my new life :)
If nothing else, because they give my Endo a good chuckle - he loves them, and loves to show them around to his med students ha ha!
But also because *I* find them interesting, even if no-one else does!

My last...

...Endo appointment before my thyroidectomy!

And bless him, he did make me laugh.

He reassured me that my current bloods looked as good as we could get them. And we indulged in a little mutual appreciation, and some metaphorical back-slapping as we congratulated ourselves on working so well together over the last few months, to get my bloods as good as we damn well could prior to the operation. To re-cap...all my levels have stayed within range for 2 months now...something we have until now totally failed to achieve since February 2008. Up until now, the *only* time my levels were' normal was during a 'snapshot' blood test taken whilst I was swinging from HypER to HypO or vice versa. So for 2 concurrent monthly tests to be within range is a momentous occasion for me!

I have to say, it has made a HUGE difference in my care to be able to see the same Endo each time I go in. In the very early days of my Endo referral I was bumped from Intern to fresh-faced Intern...and whilst some of them were absolutely on the button with their knowledge and destined to be brilliant in their future Endo careers, all too often I felt I was holding the hands of the less-experienced ones during my appointments, and having to help them along with ideas & suggestions. The fact that I'm such a regular in the Endo clinic now, that I can request (and receive) appointments exclusively with the Senior Registrar each & every time has made a big difference, and the fact that he and I get on so well together is a complete bonus!

He promised me that if there were any 'endo' issues during my stay in hospital next week that they would of course contact him in the first instance. And that if I was truly worried I should get a permanent marker pen and write "If in doubt contact Doctor Xxxxxxx on Bleep # xxx before cutting!" on my chest! Ha ha!


Edited to add: In a nod to this blog entry: CT Scan & Wedding Anniversaries , yes...my 2nd wedding anniversary will indeed be spent in hospital, attending my Endo...so at least there's no need for me to try and have an accident or something like that - just kidding! I got my hospital anniversary wish, without trying!

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

Grrrrr...Endo Woes!

Well the Endo appointment was mostly a total waste of time, diesel & effort

Both my Endo consultant and his senior registrar were out on leave, and their stand-in was an obnoxious prat, with no clue of my medical history, no clue of my medical future, and absolutely no interest in either...and who proceeded to ignore my blood results and talk *at* me for 20 minutes, holding forth as if he was the almighty righteous who dare not be questioned on anything...after 19 minutes I finally gave up and stopped disagreeing with him *LOL*

However, the nurses were delighted (for once!) with my pre-appointment weigh-in...and also confirmed my operation should be within the next 3 months.

Today's weigh-in...mixed emotions, but mostly positive.
The bad news is that I'm *UP* 2lbs this week....but the good news is that I expected more, so I am actually pleased that the damage is *only* 2lbs...there is logic there, I promise....bear with me.

Whilst I spanked the Wii Fit Plus this week like a mo'fo'....doubling my daily workouts are really pushing myself....I did also have the food weekend from hell (or heaven, depending on your view point ) and knowing this, I committed the unspeakable, cardinal sin of going off the Xenical pills from Thursday lunchtime in preparation so I could eat badly with no 'tango' concerns all weekend ...and combined with the fact that I'm smack bang in TOTM territory....I hope you can see how I would be pleased with *only* a 2lb gain. I think I'm totally indebted to Wii Fit Plus for sparing me utter mortification on the scales this morning

The line was drawn last night, and I'm back on the Xenical, and back on track this morning....that 2lb will be history this time next week

Next Endo appt is in 1 month...assuming I haven't been admitted for surgery before then.

Xenical & Blood tests

Down 2 lbs this week! Which I'm happier with Really do love Xenical!

Back to hospital tomorrow to see my Endo...and hopefully he'll be in a position to tell me more about what's going on. What kind of blocking regime they may have planned for me prior to the op...and most importantly (for me anyway) hopefully he will know roughly how long I'll have to wait now.
My bloods came back last week as slightly hypo, and a bit anaemic....so not sure where that leaves me right now ???

Stones & Scalpels

Down another 1lb this week, which is OK.
Two 1lb losses in 2 weeks, and since starting these were the only two weekends I've so far spent at home, not drinking alcohol and not eating semi-crap...go figure? Clearly if I go out drinking & carousing over a weekend I lose more weight? Good thing I've got a 3-day music festival coming up at the end of the month!

And, I hesitate to say it, but that's my first stone gone...even though I promised myself, for my own sanity not to count this in stones this time, but instead to stick to 10lb segments...but, well...its my first stone...woo!

In other news, regarding my thyroid...the appointment with my surgeon *was* my pre-op consultation, and I'm now officially on the waiting list, and due to complications with my windpipe being compressed the surgery is supposed to be sooner rather than later. I will be admitted a week beforehand because my thyroid is so toxic that they have to get my levels as near to perfect before the op, otherwise the complications afterwards will be more severe, yikes! So, guys & gals, it could be next week, next month or next year...but more likely to be within the next few months.
I mentioned my GA fears to him, with regards to my weight etc...but he said he's operated on 'larger ladies' with no problems, and the operation really does need to be done ASAP because of the windpipe problem so they are unwilling to let me go too long.
Still, I'm going to keep plugging away with the Xenical as it really is the only thing that has worked for me for years. And I'm now "Double Wii Fit-ing" each day, to really go to task on the cardio and aerobic exercises....overweight or not, I want to be as heart-fit as I can be before the anaesthetist plugs me with happy juice!

As you know, I have Grave's Disease/Hyperthyroidism, complicated by a large, toxic, multi-nodular goitre...however I have only just learned that this pesky goitre has compressed my windpipe down to less than 8mm in diameter!!! Hence the problems I have with breathing, swallowing and snoring like a "pig with bronchitis, on a freight train" I feel I surely should have been informed of this after my CT Scan last summer...I distinctly recall my Endo saying the scan was fine and everything was good...ho hum!

So there you have it...my weekly update...the weight is still coming off, and the surgery plans have been brought drastically forward!

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

Another day, another Endo

Today I got to see the Senior Registrar, and what a lovely, funny man he is!

We briefly chatted about my consultation with the ENT surgeon, and he made a few phone calls to see if he could do anything to put the 'hurry up' on my CT Scan appointment.

We discussed my weight, and the fact that I really do need to get it off, especially if I do decide to go for the thyroidectomy. He has referred me to a dietitian, to see if they can help...because as far as we can both see I'm doing all the right things, and getting all the wrong results. Of course my thyroid isn't helping, and so in order to find a way through the gloom we're both hoping that a dietitian might have a few more ideas.

He gave me some info leaflets on both the thyroidectomy, and the RAI, and then said that although the decision is still totally mine, he thought it important for me to consider a few things.

Radio-Actve Iodine Treatment (RAI)

• Obviously a lot less invasive, but....it doesn't always work first time and thus might need to be repeated.
• *might* reduce the size of my goitre, but this isn't guaranteed, and if it does reduce it, it won't completely get rid of it, so I may still have the breathing/snoring/swallowing problems.
• I'll have to stay isolated from *everyone*, including my husband, for up to 10 days afterwards. Stay away from young children for up to 2 months.
• We wouldn't be able to start a family for up to 2 years afterwards.

Surgery

• Will remove my goitre.
• Will remove my thyroid gland completely
• Will mean I'll have to take thyroid replacement medication for the rest of my life
• Will allow us to start planning a family as soon as my bloods level out after the op
• Carries risks, as any surgical procedure does, some of which may be short-term, some of which may be permanent, and include damage to the parathyroid glands (rendering the patient hypocalcaemic), voice box, laryngeal chords, damage to nerve endings causing loss of sensation, numbness etc etc.
• Not to mention they are digging about very close to some extremely important arteries there in your throat, namely your carotid.

Decisions, decisions, decisions....but I guess all this is academic until I've had my CT Scan, then we'll all know exactly what is where in there.

Routine Bloodtests 14th July 2009

I should have done these yesterday, but figured a trip to the hospital to see the ENT surgeon was enough excitement for one day. I'm currently on a monthly blood test schedule, as requested by my Endo, and as I'm due to visit him next week I normally schedule tests one week before my Endo appointment, in order to get the results back in time for him.

Was due to work in the shop today, so headed down to the doctor's surgery bright and early to be first in the queue....but no matter how early I get there (8.50am this morning) the car park is always already full when I get there, ho hum!

For some reason the needle really hurt going in this morning, and I'm truly not a wimp about these things....but my arm has remained sore all day!

I mentioned the strange patch of dark skin and dark hair under my chin (about the size of a 50c piece), and we joked that with everything else going on the last thing I need is to be growing a beard! She took an extra vial of blood and said she'd get my hormones checked this time around too.

She checked my blood pressure, and for the first almost the first time ever she was pleased with the result. When it came in at 150/80 even I cheered! Its always consistently lower when I check it at home, and after checking the accuracy of my personal BP monitor against her own sphygmomanometer in the surgery a while back, we concluded that I can occasionally suffer from white coat syndrome (Google it!) when it comes to checking my BP in the surgery. So, it seems we've finally found a blood pressure medication that seems to suit me. I did ask if there was a cheaper, generic alternative....my current BP medication (Omesar Plus) comes in at €1.24 per daily dose....and she raided her 'Sample Cupboard' and gave me 6 weeks worth, totally free of charge...result! She's done this for me in the past, and it really helps when my cash flow is so miserable.

She tried to ring the hospital x-ray department to see if she could do a 'hurry-up' on my CT Scan appointment, but all the phones were engaged, so she promised she would try again for me later, if only to make sure that a request had indeed been put in by my endo for an appointment on my behalf.

I weighed myself in my pyjamas this morning, and came in 13 lbs lighter than yesterday....amazing what a full set of clothes, and a pair of steel toe-cap boots can weigh!

Hopefully my blood results will be back on Friday, if not Monday at the latest, so I can update my graphs for whichever clueless intern gets to deal with me on Tuesday...watch this space!

ENT Surgeon Appointment - 13 July 2009

Out of bed early, after an exhausting week away. I wake up dizzy, and continue to have short dizzy spells as I got about my morning chores. A little perturbed I check my blood pressure. It comes in at 144/75, systolic is a little high at 144, but diastolic is good at less than 80...neither reading would explain the dizzy spells, so I put it down the last remaining dregs of this head cold I've been suffering from.
A quick bath, then I head up the road. I'm getting used to the alarming amount of hair that comes out when I wash my hair, regardless of the amount of conditioner I use...but its still distressing to see all that lovely hair just falling out all over the place, with very little encouragement. I often get my husband to detangle my hair after a bath/shower as I just find it too upsetting. Its easier to close my eyes and let him deal with it...out of sight, out of mind.

Its over an hours' drive to the hospital and all the way I'm chasing the ETA on my Sat Nav, inevitably I'm running late and getting stressed.
I land at the receptionist's desk at 10.57am, for an 11am appointment...and proceed to be ignored for 5 minutes as the two receptionists go about their business, discussing last night's TV with passing nurses, and basically appearing to do all they can to avoid dealing with me. I'm wondering if I'd mistakenly worn my invisible jumper when one of them deigns to notice me.
The checking-in process completed I take my seat, thankful that I'd remembered to pack a book into my handbag.

Two hours later and I'm regretting not putting two books into my bag, as I turn the last page on the book I started just two hours previously.

I sneak out of the open door for a cigarette, leaving my name with a fellow patient, also waiting patiently for their appointment, also two hours after their allotted appointment time.

Finally, 2½ hours after my appointed time of 11am I am called in to see Dr H. The first thing he asks me is if I've had my CT Scan yet. Sadly the reply is negative, and I can see from his expression that this meeting is kind of pointless without the CT results. We joke good naturedly about hospital efficiency. I point out that I am returning to the hospital in one week's time to see my Endocrinologist anyway, and wouldn't it be great if the CT Scan was scheduled for the same day, to save me an extra trip into the hospital...and we both laugh at this highly unlikely scenario. That would make far too much sense to whomever is responsible for scheduling such things.
Undeterred by my lack of CT Scan results, he proceeds to poke and prod at my neck anyway. He has a good poke in my ears (heaven only knows why?), pokes his torch up my nose....(well I suppose as an ENT Surgeon he wants to get his money's worth from any patient), before sticking his hands around my throat again for a further squeeze. He squirts yucky tasting stuff up my nose and assures me that my nose and throat will shortly go numb. I can taste ammonia, he tells me its benzocaine based....either way it stinks, and tastes horrible as it slides down the back of my throat....but it isn't half as unpleasant as the huge long scope he then pokes up my nose, and pushes down my throat. Quite a strange sensation....I don't think my throat is as numb as it should be, I can feel every centimetre of it and its at least 30cm long. Feels odd to talk to him, and answer questions, while this huge long piece of cable is sitting at the back of my throat, by way of my left nostril.
After it is removed my nose runs uncontrollably, and the attending nurse kindly passes me a packet of tissues. She advises me not to drink or eat anything for at least an hour, until the anaesthetic properties have worn off.
Dr H ponders what he has seen and announces that he thinks the Goitre on the right side has spread under my collarbone, and that this will make extraction more complicated. We will know more and have a clearer picture once this damned CT Scan has been done, but for now all we can do is speculate. Mysteriously he tells me that if it is down under my collarbone he won't be able to perform the surgery here....I assume 'here' means this hospital, but I'm not too sure what this statement means. he goes on to discuss other things and I forget to ask him to clarify this statement. I must remember to ask my Endo next week if he has any idea what this means.

Then the discussion turned to weightier matters...if you'll pardon the pun. He expressed concerns, on behalf of his anaesthetist, regarding my weight, and he stated that he'd like me to lose a minimum of 6 stone (preferably 8 stone) before he'd consider passing me over to his anaesthetist...I guess this means he won't be scheduling me for surgery either, until I lose this weight....regardless of my CT Scan results, and regardless of my thyroid problems. Oh, and he'd like me to ditch the smoking too...well that's a given, and is high up on my to-do list as it is.
I joked that I'd set about starving myself between now and my next appointment and he did have the good grace to apologise in advance for his crassness, as he quipped that "no fat people came out of Belsen".

I go back to him in 2 months time....14th of September to be precise, and I will try my hardest to have lost at least a stone or two by then. Oh, and I'll be pi**ed off if I haven't managed to give up smoking by then too. If I haven't had my CT Scan by then, well I guess it'll be yet another wasted appointment....got to love the Irish Health System....

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

Second Endo Appointment

Well I have to say that I wasn't waiting around very long this time. If anything, they rushed me through as if scared to leave me waiting at all...perhaps throwing a tantrum is the answer to getting seen on time?

They sent me for another ECG, because although I was assured the last one was in the 'OK' range...it must also have been in the 'check again' range.
This time I knew exactly where to go, I was definitely less stressed, and took time out to pause and do some deep breathing exercises before entering the hallowed ECG room. This time my results were deemed 'excellent'! :-)

Upon returning to the outpatients waiting area I was ushered in to a consultation room almost straight away.

I was with a really friendly young intern, and very impressed with her. The appointment went OK - we discussed how I was feeling, if I feeling any different to last time I was in, and why that might be. She suggested a slight dose change because, despite my TSH being within range,, albeit at the high end, my T3 and my Free T4 have gone from being too high to too low. So we dropped my Carbimazole from 40mg/day to 30mg/day.

The consultation all went well, until she checked my blood pressure...she went white with shock, and spent ages peering into my eyes, presumably checking them for any damage. She reckoned that my blood pressure dangerously high, and didn't believe me when I kept insisting I felt totally fine. She claimed that she was almost tempted to admit me there and then, and expressed concern at allowing me to drive home. I continued to insist that I was fine, and that it was most probably White Coat Disease, but she wasn't having it. She conferred with the senior consultant, and they were querying my blood pressure medication...to which I sheepishly had to confess that I hadn't been taking it. Felt pretty stupid, having to confess that if I'm honest. I explained that our money was extremely tight at the moment, and the extra prescription costs were more than I could cope with right now. They gave me some freebie samples of the Centyl-K to go home with, and made me promise to fill that prescription before they ran out. And do you know, something about the abject fear in that young interns face as she checked and re-checked my blood pressure, made me determined to find the money somehow....she was really truly scared by what she was seeing, and was acting as if expecting me to drop down dead any second. That made me feel very bad for ignoring their advice.

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.

Under Pressure

So, today I got the results back from my doctor regarding my 24hr blood pressure monitor...and whilst I was pleased enough with the averages, and could positively identify the causes of the 2 high spikes [full caffeine tea, and naughty (read: fighting) dogs]...my doctor was less than pleased. And whilst my 'waking' averages were what most blood pressure/hypertension websites consider the high side of normal or even mild-high, my doctor was still casting doom and gloom, looking at me like I was about to drop dead in front of her, and talking about that oh-so scary BP medication. Meanwhile nearly every BP/Hypertension website claims I'm well within the non-medication range...go figure, because I can't?

The way I look at it....I'm over-weight. I smoke. I currently lead a sedentary (computer-based) lifestyle, with my daily dog walks more closely resembling some mild wandering around the fields, whilst my (7) dogs run themselves into the ground. *I* know there are improvements I could make there, right now...and after the 24hr BP Monitor I'm determined to make some changes.
Oh yeah...I'm also hyperthyroid....and yeah, one of the many myriad of symptoms....high BP....so why do both my doctor and my endocrinologist choose to treat my (mild IMHO) high blood pressure as a totally separate issue, and rain fire and brimstone down on me, threatening imminent death....yet, lump all my other symptoms (hair loss, brittle nails, dry scaly skin, horrific periods, weight gain, mood swings, exopthalmia, chronic lethargy etc etc etc ad infinitum) into the mighty *thyroid* basket, and not treat *those* individually???
On the plus side, and there are a few, my cholesterol levels are low (DoG only knows how?), my blood glucose levels are well within range, my kidney and liver functions are good. My ECG results are consistently Good/OK, with no evidence of narrowing arteries or impending heart disease. So that rules out those doom-laden indicators that often go hand in hand with High BP.

So, how do I want to approach and face up to my (mild, I insist) high blood pressure?
- Well, I think, starting a good regular exercise plan is a good start....sure, I can't afford a gym membership, but walking costs nothing, and the gains are positive and immeasurable.
- Stopping smoking, that's a no-brainer....but easier said than done. Have done it successfully in the past going cold turkey....don't ask why I'm currently back smoking, after staying off them for over 18 months, let's just call it extreme stupidity on my part. In my experience the nicotine replacement therapies don't work for me, what does work for me is to give myself a thorough good talking to, get my head in the right place, and then stop, stop dead....before they stop me dead.
- Lose some weight. So far, I've lost 5lbs since Christmas, and that's without trying....I just need to show myself what I can do with a little more effort. My diet on the whole really isn't bad, no, honestly! (my hubby, who's been eating the same food as me for the last 10 years, is disgustingly slim, and got gold stars and heaps of praise from the medical team at his most recent workplace physical) But I could get a bit more strict with myself on portion sizes. Cut a little more fat out of the diet (cheese and mayo would be the main culprits), and for the sake of my blood pressure declare war on salt.
- Drop the caffeine. On average I probably drink 8-10 cups of tea in a normal day. I used to also find time to quaff up to 3 cans of Diet Coke a day. Combined with my total inability to pass a good coffee machine in a petrol station or shopping centre, and its hard to believe I wasn't wired to the moon 24hrs a day. Currently, I haven't had a single can of coke in several weeks. Bought my first box of thin (de-caff) tea last week, and managed to walk past a few coffee machines without engaging auto-pilot and filling up on hot coffee. Presently I'm having 1-2 cups of fat-caff tea in the morning, and then drinking thin (de-caff) tea the rest of the day. So far so good, and when the box of fat-caff teabags is finished I won't replace it, no matter how much hubby squeals.
- Drink more water, another easy no-brainer but a good habit I just can't seem to make stick. When I'm disciplined enough to fill an empty 2 litre bottle in the morning, then I'm generally disciplined enough to drink it....but often by the time I remember my good intentions its lunch time or later, and I give myself a thousand excuses as to why I can't be bothered to go fill the bottle and I promise myself to try harder the next day...you know how the story goes.

The BP Monitor results are a wake up call, and even if it involves lengthy arguing, pleading and bartering with my doctor and my endocrinologist, I'm determined to stay off BP medication...now is the time to listen to the alarm clock, and shake myself out of dreamland....!