azurelunatic | Let's hear it for modern medicine and the Internet!

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Let's hear it for modern medicine and the Internet!

So I had my doctor's appointment today. Did not once feel the urge to bite off anyone's face.

They don't have all their paperwork up on their website yet, so I had to fill out some of it offline. They print out their online forms to make you fill out when you're doing it by hand, hahaha.

The unexpected question I got asked was (by both the 2nd year med student and the doctor) if I'd had a lot of ear infections as a child. No, actually, as an adult. Seems there's scarring on the eardrums.

All things told, I don't have a diagnosis, but they are leaning strongly in the direction of PCOS pending bloodwork, which frankly I'd been wondering about, as I have a suite of symptoms that go nicely together. The first thing to attack is going to be my hormones, even prior to the bloodwork. They have noted that I do tend towards the depressive, and I do have a ways I can ramp up the St. John's Wort if necessary, so I hope we wouldn't have to get into some of the heavier-duty stuff they were talking about, as my moods are just fine on the St. John's Wort, thanks.

So I start the Pill now (Tri-Sprintec 28, norgestimate and ethinyl estradiol tablets, triphasic regimen, for the pharmacy geeks following along at home) to attempt to get what are probably wild hormones under control, I get to go in some morning for fasting bloodwork (may even go in tomorrow morning as I have tonight off), and they were somewhat concerned about my iron levels until I reassured them that I am used to plasma donation and how to keep my iron levels up with constant blood loss, and that totally would explain the meat, spinach, and beans I've been eating lately.

Also, I get to make a gyn appointment. I get a pap smear!

Happily for everyone concerned, I do not dread gyn appointments like some women do, namely because my experience with same has been comfortable and safe. Properly introduced doctors who do not set off my skeeze alarm have a professional pass that gets them through my touch security, so I have no problems with poking and prodding. I fear neither the speculum nor the swab.

After the bloodwork and GYN, I get a follow-up appointment, a month from tomorrow.

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Ah, PCOS is such a joy to deal with. Thankfully they know more about it now than they did six years ago when I was first diagnosed with it. The big things they check is your free testosterone levels and your insulin resistance levels. The PAP and/or ultrasound is to make sure there are none of those testosterone-generating cysts on your ovaries.

Good that you're trying to stay on top of it. I can tell you one of the first things they're going to recommend, though, coz I remember them telling me the same thing - lose weight. The heavier the woman, the more dominant the PCOS symptoms.

Michelle
aka
Samurai_ko

I would like to anyway -- the thing is overcoming the inertia (housecleaning helps, amazingly -- nice exercise and doesn't involve going Out There) and not attempting to do things that will make me balky and self-sabotaging. I could do the diet that you are on for maybe a week, at which point I would give the finger (possibly literally) to everyone involved and start eating real food again.

Suggestion for you then, since you probably can't afford the doctor that I see (the program I'm on is NOT cheap) - talk to your doc about going on a lowER-carb diet (not low, lowER). Even if you keep your other eating habits the same, cutting out some of your carbs will reduce your sucrose/fructose/glucose intake somewhat. Do NOT go completely cold turkey like I do unless you're under doctor supervision every step of the way. You won't lose weight as fast as I have, but it might be a little less painful. :)

Just something to consider - the only reason I sound like a know-it-all here is because I've already been down the road you're on. :)

Michelle
aka
Samurai_ko

I'm really not sure what carbs I can cut without triggering the "Dad is doing stupid shit with food again" buttons I have. I'm already swapping out a whole lot of refined sugar with fruit. I'm not at all likely to try no-carb ever again even with doctor supervision, because I tried that at seventeen without doctor supervision at any step of the way.

Would looking at some of the biology behind it help? It's pretty interesting stuff because it's so poorly understood. Lots of room for experimentation.

(and seriously, you *do* want doctor supervision for these kind of diet changes... even when you're just type II diabetic, dietary changes can really mess with your head)

No, I would really not like to look at biology or discuss this.

Cutting refined sugar will be a HUGE help. Certain fruits would probably be better for you than others, thanks to things like antioxidants and beta carotene and whatnot (and of course citrus has Vitamin C, always a good thing). For example, I love watermelon, but there's not really... much... THERE, is there? Not like, say, cantaloupe or bananas or something. At least one high-fiber fruit every day or so would help keep your digestion going well, too - I miss apples for that very reason.

Michelle
aka
Samurai_ko

My fruit priorities are generally whether or not I can bring it to work as a snack. Grapes seem to work the best for that.

Grapes are good, too. Especially green grapes. Red grapes are for wine. :D

Damn, now I want some... both wine and grapes, I mean. Just not together.

Michelle
aka
Samurai_ko

When you're using St John's Wort, be aware that the hormonal regulation of birth control pills might not work properly. St John's Wort increases the activity of the liver enzymes that break down steroid hormones (including estrogen and progesterone and their synthetic equivalents). Don't worry if you get much break-through bleeding, but do mention it to your doctor.

I listed that in the "drugs that I am on right now, over-the-counter" section; their main worry was that the birth control pills might cause the St. John's Wort to not work right.

*nods* That's also a valid concern, and I'm glad you told them you're on it. Hormones are powerful mood alterers.

Unfortunately, the enzyme induction properties of St John's Wort isn't well known among doctors, not even gynecologists who should know better. (The one I saw for prolonged bleeding who prescribed norethisterone, for example, had no idea at all. For me, it was pretty obvious that the dose was too low due to the SJW.) American textbooks in particular have a tradition of downplaying these effects. Since you're not using it for contraception, it's not a major interaction, but it's a good idea to keep an eye out.

I'm guessing that this is something that could be detected with bloodwork, that the effective hormonal dose in my bloodstream is too low?

Mostly, a too low dose shows as random bleeding. The right birth control dose should give you a period on the placebo week every month and no bleeding or spotting in between (after the adjustment period, of course).

Birth control pills should suppress ovarian activity completely. Taking SJW could lead to ovulation, which would show on the blood work (if they do tests for progesterone or LH), or it could mean the small PCO cysts won't go away, in which case it shows up on the ultrasound.

I'm adjusting right now. Things have slowed down considerably.

I have an idea, since you are already swapping fruits out and those are the carbs you should be eating along with veggies, I have a book I could recommend called A week in the Zone which gives you a way to balance your food out. If you are interested, since I also read the diet post, just ask me about it tomorrow. Duncan and I are trying it and you know how much I love my carbs! I actually like the food I am eating.

No, thank you.

I do not wish to discuss matters dietary with you, because your best of intentions on any matter that is sensitive to me usually wind up right smack in my boundaries.

If you have any questions about living with PCOS, you can grab me and bend my ear :)

(They tried me on the Pill first and foremost for my PCOS, and it makes me crazy. No, literally; it kicks my cyclothymia into high gear. And just going off the Pill afterward didn't help resolve the crazy. Fun times! So now I'm on the other set of PCOS therapy -- attacking the insulin resistance -- and thus far it has been interesting like whoa; the things it has done to my metabolism are Very Crazy. I swear, if there's a side effect that .02% of the population will get, that .02% of the population will include me...)

Oddly enough, my endocrinologist did NOT put me on the pill as a result of my PCOS. Instead, I was on... oh what is that stuff called... starts with "Met". It's what they actually give MALE patients to help bring down their testosterone levels after surgery. Then there was something else she put me on to deal with the insulin resistance. One small problem - I'm in that 0.02% of the population whose blood pressure PLUMMETED after that. So off I came.

Dealing with the insulin resistance can be the harder of the two, but in the long run, fixing that TENDS to fix the testosterone problem, so it makes more sense to go after that first.

Good luck to you, syne... hopefully all us crazy chicks will get this resolved one day!

Michelle
aka
Samurai_ko

Metformin? That's what

myrrhianna is on.

I *think* that was the name - this stuff was a combination of two meds in one. So it was almost like taking 3 meds (whatever two drugs make up the Metformin, and then the insulin-stuff she had me on).

Meh, my brain is mush this early in the morning.

Michelle
aka
Samurai_ko

Metformin! I'm in that .02% too -- the last checkup had mine at 92/50. But mine's always been low, and there's pretty much nothing else I can take for the PCOS, so we're just sort of tolerating it ...

See? Now you have an excuse to stress! Stress raises your blood pressure, the Met brings it back down... you're set! :D

Okay, my brain is not only mush in the morning, it's off on vacation it seems. At least your doc is aware of it and staying on top of things.

Michelle
aka
Samurai_ko

We shovel Metformin out by the truckload in my pharmacy. Lots and lots and lots of Metformin >.>

I hope you don't mind if I also interpret that as "if you have any opinions about living with PCOS that could bend metal" as well...

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Let's hear it for modern medicine and the Internet!

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