Tuesday, May 22, 2012
I finally got my visit to the endocrinologist taken care of this morning. Because of a lot of confusion a year ago when I first had it looked at (on campus, with a non-specialized staff used to treating things like Mono and STDs), I was beyond afraid of going. I was afraid I would be told I had cancer after all. Or that I needed to have the whole thing removed. Or - and this was the big one - that there was nothing to be done, and my life would forever be symptomatic, full of fatigue, hair loss, inexplicable weight gain, rampant anxiety, heart palpitations, etc. etc. So I put it off. I found every excuse I could, even after we got better insurance. Now, a year later, I finally went (though I had to have the hubby make the appointment for me).
Result? I have ten-ish small nodules on my thyroid, and one large one, though it isn't quite large enough to biopsy. All indications point to non-cancerous cysts. Hurray!! Last year, I was told there were cancerous signs by writing, but no cancerous signs verbally. No idea what happened there. I just know that being able to have the doctor conduct her own ultrasound was hugely helpful. She was able to show me how it looked, explain what I was looking at and what it meant. There's still a 5% chance the nodules could be cancerous, but there's no way to tell without removing the whole thyroid. I can live with that, especially since multiple nodules means less cancer likelihood.
That's the good part (and I'm not going to knock that - it made the appointment absolutely worth it, and I'm sure I will be relieved beyond measure and be able to move forward as soon as I process the irritation coming up here).
The bad part is that when I sat down in the exam room, I knew I was going to have problems. On the wall was a huge poster for Synthroid, the standard med for treating thyroid disorder. On the left was a list of the most common hypothyroid symptoms, and on the right, a list of hyperthyroid symptoms. I had something like 7/10 on both lists. Sucky, but it made me feel validated, which was good. The bad part was that at the top, it advocated dosage by TSH levels. From looking into thyroid problems over the last year, I know that's a bad sign. TSH is a hormone produced by the pituitary to make the thyroid do its thing. My level last year was within the normal range.
The doctor walked in and asked me if I was suffering from headaches, hoarseness, and one or two other things, to which I answered "yes." She took my family history, which she wrote in the margin beside the exact same history I'd already written down. Fine. I get that they want to make sure we don't forget anything. No problem. But she didn't ask anything else. Meanwhile, she has a GIANT list of my symptoms staring up at her, and she doesn't address symptom relief. Ever.
Just as she's leaving, I quickly ask (verbatim), "What about my symptoms? Like the weight gain and stuff?" Her answer? "Hormone treatment will not make you lose weight." Followed by a long discourse on how to properly lose weight, all of which was inaccurate. None of which actually addressed my question. She simply assumed I wanted drugs so I didn't have to work to lose weight. I didn't ask about losing weight - I don't really care about that from a medical-fix standpoint. I DO care about the three week spans wherein I gain 20 pounds for no reason at all. I care about the hair that falls out, all of which is coarse and unpleasant where it used to be fine and pretty and full. I care about the hot flashes, and the huge spike in blood pressure from heat intolerance. I care about the anxiety and the depression. I care about the heart palpitations, uncontrollable cravings, and constant fatigue. I care about my HEALTH, not my weight. None of that was ever addressed, which was exactly what I expected and was afraid of. Because I don't have a solution to improve my day-to-day life. I DO have relief, huge amounts of it, knowing I don't have cancer. But I also am going to have to deal with symptoms forever (unless my TSH, the only thing she checked, comes back screwy). (Or would, if I had any intention of having her treat me, which I don't.)
I'm very happy to have it over with, though. The super scary part is done. Now I just have to find a holistic/homeopathic doctor specializing in thyroid problems to help me figure out what to do with the symptoms. I can do that, and won't feel the pressure of guilt that I'm letting my health suffer for the time it takes to find the right doctor. I know what I'm looking for, and, armed with my great ultrasound, will be able to find the right route for me.
So good visit, all in all, but it leaves me even more disillusioned with doctors. What's the point of asking for our symptoms if they don't address them at all? How are we supposed to get better, healthier, if they don't actually focus their care that way? And why don't they refer people to nutritionists about weight loss issues, when they have no idea what they're talking about? A nutrition student told my husband flat out that doctors don't know anything about how to be healthy. It's also true of OBGYNs not knowing how to have a healthy pregnancy or strong delivery. Because that's not what they're taught. They're taught how to fix things that go wrong. That's a very great, very necessary profession. I'm glad we have them when we need them. But what's wrong has absolutely NOTHING to do with doing things right when things aren't wrong.
I weighed 244 pounds on the doctor's scale today. This is what she told me:
- Limit caloric intake to 800-1000 calories a day.
- Exercise 90 minutes 6 days a week.
- Exchange meals for protein shakes.
- Lift weights, because they're better for weight loss (after I commented that I walk at least 6 miles a week).
- Do this for three months.
This is my reality, having studied nutrition especially as it related to weight management:
- I walk while pushing a stroller to the point where my body is really working, three times a week and supplement with dance sessions whenever I can. I break a serious sweat (which is saying something, since I have decreased sweat production).
- Yesterday, I walked two miles in 40 minutes (I usually manage faster, but it was HOT). According to SP, that burned about 250 calories (not counting the sun factor or stroller, so it would have been higher).
- If I were to do that for 90 minutes, I would be burning roughly 450 calories.
- With a diet of 800 calories, that gives my body 350 to work with. To keep my heart, lungs, brain, etc. functional.
- 300 calories is the extra draw that *breastfeeding* requires. (I'm not currently breastfeeding, just using it to illustrate bodily needs.)
- My basal metabolic rate, the number of calories my body burns just to function, is about 1800. In other words, I need to ingest 1800 calories every day just to keep my body functioning while laying in bed. That goes up with any physical activity whatsoever. If I eat 1800 calories (assuming normal metabolism) while on complete bed rest, I will maintain my weight. Any activity above that without increasing caloric intake will cause me to burn fat for fuel.
- Strength training builds muscle, which in turn burns fat. But there is no real fat burning without oxygenated, aerobic exercise. All that muscle can't do diddly if the body doesn't turn on the chemical fat burning process through aerobic exercise.
- If there aren't enough calories coming into the body, all unnecessary functions slow down. It decreases mental focus, digestion, oh, and muscle building. Because it's taking in as many calories as it can hang on to, it also slows down the metabolism to a dead crawl. Which means no fat burning, which means no weight loss.
- 800 calories is how much is in a pint (the little container) of Haagen Daz frozen yogurt, or a large milkshake, or 1.5 Chick Fil A sandwiches.
- At 800 calories a day, even without the exercise, I'd be anorexic. I wouldn't look it, but I would be actively starving myself as much as a 60-pound teenager who is all skin and bones. My body would eat itself, and shut down all but the very most important organs and processes necessary to keep me alive.
- Three months of that, and I think I would probably be in system failure...if not dead.
- There is no way I could even sustain that more than a day, because I'd pass out by lunchtime on day 2.
Healthy? I don't think so!
Discussing this with my husband, who was equally shocked at the doctor from just hearing me discuss nutritional concepts in the past, I realized something. I have this dream. I'm not really sure if it's a dream I want to make reality, but I think it would be absolutely amazing. And if I really want to make it happen, I should at least figure out what it would take to create it. The hubby, who has a Master's in Business, volunteered to look into it for me. He also agreed to be my guinea pig. I will post about the dream later. The experiment I'm going to run with him is to see if I can create a nutrition and wellness plan to help him lose weight, based on what I've learned and experienced. He promised to stick with it. I'm really excited about both things!
And, 95% chance non-cancerous! Yay!