Daily Inspiration: 1/31/08

The essence of living is discovering. Indeed, it is the joy of discovery that makes life worth the effort. - Vijay Krishna

Allergies Linked to IBS

One of the things that I likely have but have never been officially diagnosed with is irritable bowel syndrome (IBS).

There is now a study out that shows a link between allergies and IBS.

This makes perfect sense to me in so many inexplicable ways. And it's just one more thing to show that there's a connection here. Remember that song that goes "the hip bone's connected to the leg bone..." etc? I feel a chorus of that coming on.

This also plays into my Inflammation Theory. The theory, without anything other than my personal experience, is that I believe people with the issues that I have are more suceptible to inflammation from one source or another. Some are more sensitive to insulin, some are more sensitive to allergens. Some are sensitive to both. Regardless, this oversensitivity leads to chronic problems that are both caused by and exacerbated by inflammation from whatever the source was in the first place. Thus, I believe the first step in treating any of these things is finding the trigger item and eliminating it while working on other treatment options. It's not possible to do that in all situations, but limiting contact or finding ways to de-sensitize is the key.

Physical Therapy Results

I'm about two and a half weeks into PT now and I'm starting to feel some results. They're small, but I can tell you that I'm less sore today after I had PT yesterday than I have been any day after PT yet.

It may not sound like much, but that's progress to me. And I'll take what I can get.

My ultimate goal is to be ready to start walking and/or going to the gym in a few weeks. Because I can't handle that now.

Daily Inspiration: 1/30/08

It is wise to direct your anger towards problems -- not people; to focus your energies on answers -- not excuses.
William Arthur Ward

Daily Inspiration: 1/29/08

This Henri Tolouse-Laurtec painting, "The Bed," is my favorite all-time painting. The reason I love it is the expression of intimacy between the two people who aren't even touching.

This serves as inspiration in that it reminds us that our closest relationships are not about touching, not about physicality, but about strength in intimacy--especially when our bodies are letting us down.

Hitting the Big Time: Vulvodynia in the NYT

The NYT has a really good article about vulvodynia today. Sometimes articles like this tell me things I already know, but this one, in addition to providing a good overview, is in depth and provides new information.

One part about a new study regarding the cause of the condition was extremely interesting:

Dr. William Ledger, professor emeritus of obstetrics and gynecology at the Weill Medical College of Cornell University and an expert on vulvodynia, said, “It is clear that there are subdivisions of this condition — one diagnosis doesn’t fit everyone.”

Working with Steven S. Witkin, Dr. Ledger has found two genetically based predisposing factors. In one, the women produce inadequate amounts of a substance that blocks an inflammatory response. “They get an inflammatory response to an infection,” Dr. Ledger said, “but it doesn’t go away.”

Another genetic aberration results in unstable production of a substance that normally responds to an invasion by yeast or bacteria, placing them at increased risk of chronic infections.

Using a dermatological instrument that reveals two cell layers beneath the skin, Dr. Ledger said, “we’re seeing much more widespread inflammation in these patients than appears to the naked eye.” He added that he had treated patients who had vulvar inflammation with local estrogen or steroids; while they looked 80 percent better on the surface, their symptoms were only about 20 percent better, because the inflammation remained beneath the surface.

In addition, Dr. Ledger said, “there’s good evidence that with vulvodynia as a whole, the women have more nerve fibers in the vulva and they are firing more pain signals to the brain.” He continued: “It’s a kind of vulvar fibromyalgia. Most patients with vulvodynia have very tender glands at the entrance to the vagina.”

In fact, several recent studies have shown up to a tenfold increase in the density of nerve endings in what is called the vulvar vestibule. In some cases the women appear to have been born with this overabundance of nerve endings. But as Dr. Andrew T. Goldstein, a gynecologist at Johns Hopkins School of Medicine, and colleagues reported in 2006 in The Journal of Sexual Medicine, excessive nerve endings may also be caused by nerve growth factors after an inflammatory response or from hormonal changes like those induced by oral contraceptives

Very interesting, indeed. It plays into my whole inflammation theory--that all of the things I have are caused by a degree of inflammation which is greater than the normal human or a reaction to inflammation that is abnormal.

The treatment section of the article is a bit light, offering only surgery and drugs as an option, when we all know there is more than just that. But all in all it's a great article that's not only informative, but for those of us with it, provides reassurance.

Daily Inspiration: 1/28/08

"Medicine, the only profession that labors incessantly to destroy the reason for its own existence."

- James Bryce

Is Lyrica doing anything but adding pounds?

I've been taking Lyrica fairly regularly for a few weeks now. I can't say it's done anything. I've read a lot about this on the internet--that it may just be a placebo effect. I guess, but I have gained weight on it and it can make you woozy until you're used to it. So it's doing something.

I'm thinking about stopping it.

Maybe I'll give it one more week, making sure I take it regularly, and see if I can see ANY benefit. If not, it's out of here.

Weekend Inspiration: January 26-27, 2008

Big Girl, You Are Beautiful....Mika

Enjoy!

Daily Inspiration: 1/25/08

I'm going to start a new daily feature on this blog that is just a piece of inspiration. Enjoy!

----

"Most of the important things in the world have been accomplished by people who have kept on trying when there seemed to be no hope at all."
Dale Carnegie

Are we the illness or do we have the illness?

This post on Keep Working Girlfriend (a site about coping with chronic illness) talks about the difference between being the illness and having the illness. This is true of any illness.

It's an interesting and powerful topic. And I agree with it to a good extent, but as I posted in the comments to it, it's a realization that happens over time--being the illness for awhile to learn to control it is a good thing. I'm not saying stop your life, but it's a new awareness into something that permeates everything you do. It's only when we learn about our limitations and feelings that we learn to move past them and back into our roles at home, with family and friends and at work.

Definitely a good read.

Starting to be normal...

This article from the LA Times, reprinted below, talks about how girls are going through puberty earlier and earlier. A girl going through puberty at 8 or 9 is no longer abnormal. Guess I'm just ahead of my time.

I truly think this is related to PCOS and insulin resistance. There's something in our environment or our diet that wasn't there a hundred years ago, and it shows.

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Girl, you'll be a woman sooner than expected

Puberty is arriving ever younger in American females -- 8 is no longer considered abnormal.

By Susan Brink
Los Angeles Times Staff Writer

January 21, 2008

AT 8 or 9 years old, the typical American schoolgirl is perfecting her cursive handwriting style. She's picking out nouns, verbs, adjectives and adverbs in sentences, memorizing multiplication tables and learning to read a thermometer.

She's a little girl with a lot to learn.

And yet, in increasing numbers, when girls this age run across the playground in T-shirts, there is undeniable evidence that their bodies are blossoming. The first visible sign of puberty, breast budding, is arriving ever earlier in American girls.

Some parents and activists suspect environmental chemicals. Most pediatricians and endocrinologists say that, though they have suspicions about the environment, the only scientific evidence points to the obesity epidemic. What's clear, however, is that the elements of female maturity increasingly are spacing themselves out over months, even years -- and no one quite knows why.

While early menstruation is a known risk factor for breast cancer, no one knows what earlier breast development means for the future of girls' health. "We're not backing up all events in puberty," says Sandra Streingraber, biologist and visiting scholar at Ithaca College. "We're backing up the starting point." She has examined the research on female puberty and compiled a summary in an August 2007 report called "The Falling Age of Puberty in U.S. Girls." The report was financed by the Breast Cancer Fund, an advocacy group interested in exploring environmental causes of that disease.

Earlier breast development is now so typical that the Lawson Wilkins Pediatric Endocrine Society urged changing the definition of "normal" development. Until 10 years ago, breast development at age 8 was considered an abnormal event that should be investigated by an endocrinologist. Then a landmark study in the April 1997 journal Pediatrics written by Marcia Herman-Giddens, adjunct professor at the School of Public Health at the University of North Carolina, Chapel Hill, found that among 17,000 girls in North Carolina, almost half of African Americans and 15% of whites had begun breast development by age 8. Two years later, the society suggested changing what it considered medically normal.

The new "8" -- the medically suggested definition for abnormally early breast development -- is, the society says, 7 for white girls and 6 for African American girls.

Through the ages

Puberty involves three stages: breast development, pubic hair growth and, finally, menstruation. Because the final event is typically the most memorable for women, it has been the one most scientifically documented in studies based on self-reported memories. The first 100 years that medical records were kept on the age of onset of menstruation saw continuous drops. Between about 1850 and 1950 in Europe, the average age of a girl's first period dropped from about 17 to about 13. (The U.S. doesn't have good data earlier than the 20th century, though trends were probably similar, says Steingraber, who prepared the August 2007 report after examining hundreds of studies on potential dietary, lifestyle and environmental causes of early puberty.)

Much of that decline probably has to do with better nutrition and public health improvements that reduced the spread of infectious diseases. "Better diet, closed sewer systems, deep burial of the dead," Steingraber says. "By the beginning of the 20th century, those things were in place."

Adequate food and good health signal the brain that it's safe to reproduce, according to theories of evolutionary biology. "We're healthier and we weigh more," says Dr. Francine Kaufman, head of the center for diabetes and endocrinology at Childrens Hospital. "In some ways, puberty is a luxury."

With the brain picking up these signals, the hormonal parade can begin, first with the release from the hypothalamus of gonadotropin-releasing hormone, which sends other hormones from the pituitary gland through the bloodstream to the ovaries. The ovaries gear up production of a form of estrogen called estradiol, which initiates breast development -- the first step in puberty.

A second signaling pathway stimulates the adrenal gland to begin androgen production, which results in pubic hair. The final stage of puberty is the beginning of monthly periods.

But the first two events are happening significantly earlier in the lives of today's girls than they did in the lives of their mothers and grandmothers. The age of first menstruation has dropped too, at a rate of about one month per decade for the last 30 years, according to a January 2003 study in Pediatrics. Today, the U.S. average for first period is 12.5 for white girls, 12.06 for black girls and 12.09 for Latinas.

The gap between the first appearance of breast buds and menstruation grew wider by as much as a year and a half between the 1960s and the 1990s, according to research published in the October 2006 journal Current Opinion in Obstetrics and Gynecology. The time from breast buds to bleeding, according to Herman-Giddens, is now close to three years.

In short, that finely tuned biological process may have reached a tipping point. Since the 1960s, Herman-Giddens says, the decline in the age of maturity has crossed the line from positive reasons, such as better diet, to negative ones, such as eating too much, exercising too little and the vast unknowns of chemical pollution.

The lack of adequate explanation has some experts worried. "Over the course of a few decades, the childhoods of U.S. girls have been significantly shortened," Steingraber says.

Redefining 'average'

The new average age of puberty, some fear, may be like the new average weight -- typical, but terrible.

"My fear," Herman-Giddens says, "is that medical groups could take the data and say 'This is normal. We don't have to worry about it.' My feeling is that it is not normal. It's a response to an abnormal environment."

Dr. Paul Kaplowitz, chief of endocrinology at Children's National Medical Center in Washington, D.C., and lead author of a special article Oct. 4, 1999, in the journal Pediatrics suggesting a redefinition of early puberty, isn't so sure. Too many girls are being labeled abnormal, he contends.

"Maybe we shouldn't be worrying so much about those girls," he says. "The chance of finding a serious condition in a 7-year-old with pubic hair is very, very small."

There have always been rare cases of extremely early puberty, called precocious puberty. One report, going back to 1834 in Butler County, Ky., was of a baby girl whose hips and breasts began to grow soon after she was born. By the age of 1, she was menstruating and at age 10, she gave birth to a 7-pound baby. Such extreme cases today would be examined and treated.

But the beginnings of breasts, and the first pubic hair, at ages 8, 7 or even 6 for African Americans falls at the low end of today's new normal range.

With statisticians proving that "average" is younger than recently thought, environmental activists are asking whether hormones in food, pesticides in produce or phthalates in plastics and cosmetics could be contributing to breast buds in third-graders. Social scientists have lifestyle suspicions. Does the stress of fatherless households, or the stimulating effects of sexually suggestive television shows, have anything to do with earlier signs of puberty? The suspicions remain difficult to prove.

Despite the reassurance of pediatric endocrinologists that younger development is normal, a lot of parents are still nervous, Kaplowitz says.

"If somebody calls in and says, 'I've got an 8-year-old with breast buds,' there's nothing I need to do," he says. "I discourage referrals. But they show up anyway."

Kaplowitz examined evidence for all suspected environmental and lifestyle factors in his book, "Early Puberty in Girls: The Essential Guide to Coping With This Common Problem."

"The explanation for which there's the most evidence is that it's related to the trend in increasing obesity," he says. "There are other factors, such as if your mother matured early. Sometimes we simply don't know. But overall, the biggest single factor is the trend toward obesity." Fatty tissue is a source of estrogen, so chubbier girls are exposed to more estrogen.

"With environmental influences, there has been a lot of speculation, but little hard data. I'm not suggesting there's no connection, but it's very hard to say there's a proven connection. I think it's environmental mainly in the sense that overeating and lack of exercise is environmental," Kaplowitz says. "I've tried to take the view that we shouldn't be alarmed about this."

Herman-Giddens is not so convinced, but concedes that evidence for environmental causes is close to impossible to obtain. "I myself am shocked sometimes to see very thin girls, 8 and 9 years old, with breast development," she says. "But with all the estrogen-like elements in the environment, it's virtually impossible to study. There's no place to find an unexposed population."

The biggest concern, she says, is that earlier puberty means longer lifetime exposure to estrogen, and early puberty, along with late menopause, is known to increase the risk of breast cancer.

But to design a study in which some girls are deliberately exposed to higher doses of such chemicals would be unethical, she says. Some animal studies provide cause for concern about endocrine-disrupting chemicals, but little hard evidence for humans. And a handful of industrial accidents have provided some data. In 1973, for example, estrogenic chemicals were inadvertently mixed in cattle feed in a Michigan community. The daughters of pregnant and nursing women who ate meat and dairy products from the cows were studied and were found to have begun their periods up to a year earlier than girls not exposed to the chemical, according to a 2000 study in the journal Epidemiology.

Time for a talk

What's clear is that physical appearance is getting ahead of other aspects of girls' maturity. They might be perceived as far older than they are, even when they're still rummaging through their mothers' closets to clomp around in oversized high heels.

"My daughter started developing breasts maybe around age 8," says Rhonda Sykes of Inglewood. "She was still into her doll phase and dressing up to play." So Sykes began having frank mother-daughter conversations about curves and changing bodies a bit earlier than she expected.

"Whatever they look like, they know nothing," says Diana Zuckerman, president of the National Research Center for Women and Families. "Eight- and 9-year olds are learning to make change for a dollar. These are children who are learning the most fundamental facts in school. Imagine trying to teach that child the fundamentals of sex. They're not even playing Monopoly yet. They're still playing Candyland."

The medical community calls earlier puberty normal, the trend goes hand in hand with the obesity epidemic, and science has not yet pinpointed the reasons. And yet, when girls who are still children in the minds of their parents start developing breasts, many of their mothers remember that it happened later in their own lives -- and wonder why.

Theorists and advocates continue to search for definitive evidence, and little girls continue to look like young women at earlier ages. "My biologist brain says, 'There's not a lot you can conclude from the [environmental] evidence,' " Steingraber says. "But I've got a 9-year-old girl. And as a mother, I say, 'They've introduced all these chemicals into the environment, and they have no idea what it's doing. What are they, nuts?' I want data demonstrating safety, not data demonstrating ignorance."

Another reason I'm glad I started taking Chromium

This piece shows that chromium is also good for brain function and memory.

This is in addition to it being good for insulin levels/glucose levels.

If this is true (and I think it is) I'm so screwed

Apparently clutter isn't only annoying or unsightly, it's bad for your health.

But experts say the problem with all this is that many people are going about it in the wrong way. Too often they approach clutter and disorganization as a space problem that can be solved by acquiring bins and organizers.

Measures like these “are based on the concept that this is a house problem,” said David F. Tolin, director of the anxiety disorders center at the Institute of Living in Hartford and an adjunct associate professor of psychiatry at Yale.

“It isn’t a house problem,” he went on. “It’s a person problem. The person needs to fundamentally change their behavior.”

I know this is true, but I will forever use lack of space as an excuse. I just know it.

Here's the really true part:

Excessive clutter and disorganization are often symptoms of a bigger health problem. People who have suffered an emotional trauma or a brain injury often find housecleaning an insurmountable task. Attention deficit disorder, depression, chronic pain and grief can prevent people from getting organized or lead to a buildup of clutter. At its most extreme, chronic disorganization is called hoarding, a condition many experts believe is a mental illness in its own right, although psychiatrists have yet to formally recognize it.

True dat. A solution?

On its Web site, www.nsgcd.org, the group offers a scale to help people gauge the seriousness of their clutter problem. It also includes a referral tool for finding a professional organizer. But since the hourly fees can range from $60 to $100 or more, it may be worth consulting a new book by Dr. Tolin, Randy O. Frost and Gail Steketee, “Buried in Treasures” (Oxford, 2007), which offers self-assessments and advice for people with hoarding tendencies.

I went and looked at the scale and apparently I'm not as bad as I think I am (or my husband thinks I am). Interesting...now I have evidence!

In any event, regardless of its reputation as a true disorder or whether it's a symptom of other disorders (I think this is probably the true cause), I don't think anyone can say that they want a disorganized living space. The hard part, in this case, isn't admitting it, but fixing it. And pain really does get in the way.

Two Interesting Insulin Related Science Pieces Today

The first one is about the causes of insulin resistance, which ultimately may lead to a cure (or at least better treatment options.) Basically, the scientists believe that there's a "metabolic traffic jam" in people with IR which causes the body to be unwilling to run off of stored fat and instead runs off of glucose from food intake.

Interesting.

The second is about the role of C-peptide in insulin production.

This one I understand less, but it seems interesting. And there's some MSU folks in on the research.

Pumping Iron

I've had trouble with multivitamins in the past. So I consulted my father in law (who is a retired pharmacist and also has Type II diabetes) about what vitamins to take with metformin. In a car-problem-induced trip to the mall, I stopped by GNC and picked up the following:

B-50 Complex (as metformin blocks B vitamin absorption)
B-12 Tablets (see above)
Chromium 400 mcg tablets (helps insulin levels)
Cinnamon capsules (helps insulin/glucose levels)

I've taken cinnamon before, but the others are new. I keep telling my husband that I'm going to get all tough like metal from the chromium. I took them yesterday and forgot this morning. But then i thought that it might be good to take them at bed time anyhow as they may cause some nausea.

I was thinking about adding Vitamin D as Vitamin D deficiency could be the cause of some of my exhaustion. We'll see how this goes.

I didn't know until this weekend that cinnamon is an "oriental herb" (according to the GNC bottle). Apparently it's true. Who knew? I never associated cinnamon with anything Asian. Well, I'll be damned.

Bear this in mind

Chomium can be helpful for insulin resistance. I've actually heard this somewhere before, but it's nice to hear a personal perspective.

So this weekend my goal is to get started on cinnamon (500 mg) and chromium (300 mg) and possibly a B complex vitamin. I've been told by my retired pharmacist father in law that I need B vitamins to supplement my diet with the metformin.

Onward and upward!

A Tisket a Tasket

...a muscle lined basket.

I had my first appointment at physical therapy today. We didn't do any therapy, just background, etc. I have homework--keeping a log of my "voiding" for one day. I'm so not thrilled to do this.

But most importantly, my PT showed me a model of a pelvic floor muscles with the pelvis. it looked so funny--you never see the two together. In sex ed we'd see vagina models. And at the chiropractor you see the pelvis model--but never together. I always wondered how everything was held in place.

Turns out, it's just like a basket.

And all of the diagrams suddenly fell into place, some more of my symptoms (that I never thought of as symptoms) made sense. It was wonderful.

There is a picture of something very similar to what I was shown above. I thought it might be helpful to others.

(Side note--in searching for a picture of that model I noticed the cost--like $500. I wonder what a real one would cost. :))

Music to my ears...

I had my appointment with Donna, the nurse practitioner at the WISH program at Beaumont. I cannot recommend this program enough. She thoroughly went through my health history and non-health history to put together a timeline of not only my symptoms, but perhaps some causes. She also did a brief exam and gave me some solutions.

Two medical things she did for me--gave me a prescription for a lidocaine ointment for the vulvodynia and gave me a prescription for Lyrica for the PFD and the vulvodynia.

I have to be honest, I haven't used the ointment yet. I think I'm kind of scared of it. I also kind of feel like if I'm not doing anything down there, I'd rather not numb it up.

I have tried the Lyrica. (I thought it sounded familiar and I was right--it's the commercial with the woman that I can't stand her slow and deliberate rate of speech.) As promised it makes me a bit woozy. It does not, however, make me sleepy. It just kind of makes things less focused. I took one last night and it did help me sleep and then I took one this morning before I realized that it was why I overshot my alarm. The first half of the day at work was a bit out of focus. And I don't mean that in the "I can't focus today" kind of thing, but the "the screen looks fuzzy" out of focus.

But, I can tell you that I think it works. Though I'm about to start my period any moment now and usually that would have me doubled over in pain, I was fine throughout the day. I started to have some pain at the end of the day and took another pill when I got home and I was fine.

And in other good news, I start physical therapy on Friday. Though I was told the waiting list was going to take a couple of weeks, I got a call yesterday and I'm in on Friday. Beautiful.

So all in all, some solutions are coming.

In PCOS related news, I am thinking of switching endos. As much as I like my current guy, I have issues with him and it's impossible to get in. I got an e-mail from the Southeastern Michigan Cysters yahoo group talking about an endo out of Henry Ford. That's the other thing--I'd like to keep everything in Beaumont. But if he's going to work, then I'm all over it. I'm going to call tomorrow if I get a chance.

A new fight to fight...Pelvic Floor Dysfunction

So, as I mentioned in my first post, I went to see a urologist that specializes in IC this morning. I went out a little less of an IC patient and a lot more of a pelvic floor dysfunction (PFD) patient. To be honest, I have mixed feelings about it as I've been working on this IC thing for a year and a half now, but I'm also calmed by the fact that it explains some of my symptoms that have been ignored until now.

Next steps:
Visit with a nurse practitioner to coordinate PFD care, review other options, etc. (tomorrow)
Start physical therapy for PFD (when my turn on the waiting list comes up)
Research the heck out of this (now until forever)

The PFD diagnosis also begs the question--is this connected with my PCOS/IR? I have a feeling that it is at least in one way. The Body Chronic moves very subtly, but if you look closely you can find the path it took. Sometimes you run into a chicken and egg problem, though and I fear that's where this will lead me.

So with that cat officially out of the bag, I feel as if I can actually focus on the PCOS/IR more than if IC were the main cause of my pain (note: IC may still be a diagnosis for me, but the PFD appears to be primary, the treatment of which could lead to much alleviated IC symptoms). I don't know why I feel somehow that I had to tackle one or the other if it were IC and PCOS/IR but with the PFD and PCOS/IR I can tackle the problem more holistically. Maybe that's something to explore in and of itself.

For now, here are some helpful PFD links that I have found thus far:
Transcript of a presentation by Dr. Moldwin from the Albert Einstein College of Medicine about PFD
IC and PFD from the Interstitial Cystitis Association
A very techinical analysis of PFD from Raul Ordorica, MD
A more narrative description from IC Advice

First Post--What is this all about?

Part of my New Year's Resolution is to keep better tabs on my health. As someone with a few major syndromes, I figured this would be not only a way to keep tabs on it, but a way to share my experiences with the greater community so that others may learn from it.

I have Poly Cystic Ovarian Syndrome (PCOS) and Insulin Resistance.
I have Interstitial Cystitis.

Nowhere else on the internet have I heard those two subjects and their interconnectedness discussed on the internet. I have an inkling that YEARS from now they might find a connection, but nothing is going so far. So for my own sanity, and possibly the sanity of others in my position, I'm going to create a space for learning, investigating and expressing.

And hopefully in documenting my journey and bringing others into the fold, we can unveil some solutions that help us all.