Change of Pace

As I have mentioned previously, I had been seeing a new endocrinologist recently. At first I was excited by this prospect, but my faith in the relationship had been tested along the way to the point where I wasn't sure he was the doctor for me. It took me some time, but I knew from the first meeting that this would be a relationship that, at the very least, would take some work.

At our last meeting I was less than encouraged. Though he put me on Byetta as requested, and supported the decision, there was still this nagging feeling that there wasn't the right mix involved. Here were my warning signs (some of you may relate to these things):
1. He advocated very early on (early in the first appointment) that I should consider weight loss surgery. (WLS)
2. He wanted to see me every 2-3 weeks.
3. After the initial 2-3 weeks when I did not lose weight, I was made to feel as if this were some grave dissapointment.
4. He wasn't as concerned about my lifestyle choices as he was about the pure numbers--weight, insulin levels, glucose levels, etc. Nor did he ever put any effort into discussing the lifestyle choices which would affect those numbers such as food choices, exercise levels, other conditions, etc.
5. He did not seem to take into account my other chronic illnesses in any of our discussions.

Nevertheless, I gave it a good try--even though his office was at least 45 minutes away from work or home for me. I have often had to cancel appointments for this reason. But I thought there weren't many options.

Somehow, I came across another name, a woman no less (which I prefer for several reasons) who was in between home and work. I met with her this morning and she decided to give the Byetta another try (even though it was helping, I had decided to give it a rest until I made a decision about the direction, if any, I wanted to pursue with my IR/PCOS). She also kept me on the 2000 mg of Glumetza. Here are the things that made me feel more comfortable with her and her decisions:
1. She did not mention drastic (and frankly dangerous) measures such as WLS.
2. Although she noted that weight reduction is critical for PCOS, especially if I ever want to conceive, she did not push that as the be-all/end-all.
3. She listened to me and did a thorough background history.
4. She advocated lifestyle changes.
5. She advocated me tracking my blood glucose levels fairly regularly to ensure that I wasn't treading on the line between IR and Type 2 Diabetes.
6. She understood the connection between my weight loss and eventual regain due to other chronic conditions.
7. She made the next appointment 3 months out--time for me to actually make a reasonable difference in my life.

I am optimistic about these changes. More importantly, I am, once again, comfortable with the care I am receiving. The thing is that when you have a chronic illness, you have a greater awareness of the quality of the care you receive. In the same vein, you are in greater need of a greater level of care. If a doctor does not take into consideration all of the conditions that your body has (whether they be illnesses or just facts of your life), then you are going to be boxed into certain failure in the quest to live a better life.

Not only that, but I realized the weight that was lifted off of my shoulders by having a positive experience. Granted, my weight was up from my normal weight and I'm not feeling myself all over, but for the first time in a long time I felt empowered to do something about it, instead of hounded. As opposed to feeling that I can never please my medical professional, I feel like my medical professional is trying to help me please myself.

It's a start, but it's a great feeling.

Hello/GoodBuy--Byetta

Though I haven't talked about it in any great detail here, I have started Byetta to control my Insulin Resistance and PCOS. It was a tough choice--the doctor's agreeing to put me on it was not necessarily for the same reasons that I wanted to be on it (he wants me to lose weight, I want to stabilize my weight and then go from there).

I have been on it for about three weeks now. It's a pain because it's an injection pen. The injection is barely noticeable, except for the fact that I now have a couple of bruises on my stomach from the injection sites. They don't hurt, they're just there.

I was fearing the worst in terms of side effects. Luckily my body (which has had its share of medicine chucked at it over the years) was resilient and I have yet to have any really disturbing effects. Some nausea, but to be honest, I'm nauseous half the time anyhow.

I have noticed that it has decreased my appetite immensely--which during my trip to Vegas made the trips to the buffet a little less economical. One plate for $25 is not the same as if I had stocked up. Nevertheless, I was dilligent for the first half of my vacation. I gave up the last few days. It wasn't any real choice--I just forgot.

But I have noticed my weight stabalizing, even after the great Lyrica Disaster of 2008. I may have even dropped a few of those added pounds, which would be nice. But more importantly, I feel as if my hunger isn't driving me unnecessarily now.

Sometimes with insulin resistance, part of the problem is not only that your body can't process carbs, but that your body craves them uncontrollably. I learned this after first being diagnosed with IR and reading the Insulin Resistance Diet. Once you get the insatiability under control, I've noticed, you're better focused and less tired. I feel like the Byetta has helped me do just that.

This has played into my whole Thin Line of Fat situation, though. Now that I've stabilized and that I've made progress with the PFD--am I ready to go back to the gym? Am I ready to tackle a low carb, high protein diet? Will it even matter? I guess only time can tell.

For now I'm just catching up on life post-vacation. One small step for me, one giant leap for my insulin resistance.

The Body Chronic Strikes Back

I've been meaning to blog about my Day o' Doctors on Tuesday, but I haven't had the time nor the energy. It's an important story to tell, though, because it compacts a lot of what I've been going through into one stressful day.

9 a.m.
I go to see the nurse practitioner about my PFD/IC/VV. Last time I was there she gave me a prescription for Lyrica and a prescription for lidocane ointment. Neither have worked well. The Lyrica has cause me to gain about 15 pounds in a month and my clothes are much tighter. Not to mention, I have issues with weight gain/loss anyhow, I don't need any more uncertainty in that department. The lidocane wasn't not working but it wasn't working either. I'd have bouts of stinging and burning for 10-15 minutes after applying it that would cause me to flare up. The numbing properties were totally outweighed by this.
Now, instead, I'm on Neurotonin, which is like Lyrica only allegedly devoid of some of the side effects. I've only been on it for two days really, so I can't tell. I also have a small dose of Flexirill to take for muscle spasms. And the lidocane has been replaced by a compounded medecine cream with elavil in it (and other things). I still have to get the last one filled.

10 a.m.
Enjoy breakfast at a coney island. Go to the pet supply store to get cat food.

11 a.m.
Go to physical therapy.

1:30 p.m.
Go to new endocrinologist. Not surprisingly he bumps up my Metformin from 1000 mg to 2000 mg per day, orders blood tests and actually switches the Metformin to Glumetza, which has fewer side-effects (allegedly). I asked about Byetta after reading about people's success with it on the Soulcysters board. He says it might be a possibility but we should get the blood results first. He brought up the dreaded "obesity" word and the idea of bariatric surgery. He told me to keep an open mind but I've pretty much already made up my mind in the negative on that subject.

5:30 p.m.
Go to therapy...and definitely need it after having such a hectic day of doctors and medical professionals.

Net gain of medications: 1
Net gain of pills to take per day: 3 (Glumetza only comes in 500 mg)

So far, I haven't been able to tell anything except the following:
1. The Glumetza while not as harsh as the Met still has some side effects. I've had a couple bouts of nasty afternoon-nausea at work from it. I've decided to split it up--1000 mg in the morning, 1000 mg at night.
2. The Neurotonin/Flexirill makes it really hard to get up in the morning.

The one thing I have simply GOT to do is to change my eating habits. But I know what it requires and it's not easy. I've had much success before with a low-carb lifestyle and exercise, but my circumstances have changed a lot since then. But more than that I know how hard it was for the first month especially. And I'm not sure I currently have the inclination to put myself through that.

So we'll see. As all things medical go, we shall see.