Hyponatremia

On Saturday I went to my appointment with Dr. B. I was almost excited to be there because I knew that I had lost another 3 pounds and I wanted to see the results of the blood tests from the week before. I was hoping that my potassium levels would be normal, and they were. My cholesterol levels were stellar and again my A1c was 5.0. I wasn't anemic in any of the vitamins that I tend to run low on and my protein and iron levels were good. Unfortunately all was not well. My insulin levels have continued to rise despite getting my A1c under control. I find this frustrating; the reason I have been putting so much effort into weight loss was to get my blood work on target, especially my insulin levels. That has yet to happen. But that wasn't the biggest problem. My liver enzymes  have climbed to a level that is three times what they should be and my sodium and chloride levels were very low. This was the second time recently that my liver has shown signs of distress, but not second time in a row. And while I was concerned about my potassium levels getting too high, I had not even considered that I could become hyponatremic. J, Dr. B's NP suggested that I needed to get tested for hepatitis A&E, and that I should consider eating a lot of salt. This is in direct contrast to what Dr. B was saying two weeks earlier. Dr. B was concerned that the amount of sodium I was eating was causing inflammation that was the cause of my almost constant water retention. She suggested that I try limiting sodium in my diet to 1500 gms a day. They ordered more blood tests and said that they would be sending the blood work that they had to Dr. R.

I was expecting a call from L at Dr. R's office and was surprised when on Monday I didn't hear from them. I hoped that it meant that Dr. R thought I could wait until my appointment on the 9th to deal with it. Well, no such luck with that. Dr. R called Tuesday evening right as I was packing up to leave my cube. He said that he was very concerned that my sodium level was down to 124, and that is a potentially lethal level. He asked what Dr. B had suggested I do about it. I told him that she doesn't treat anything but obesity and will refer anything else she finds to him. Dr. R is also concerned about the high liver enzymes that I have and wants to do some tests to see what could be causing the problem. He told me to go back down to the 25 mg a day of spironolactone. I hoped he'd also say to hold the simvastatin and trilipix since my cholesterol is doing so well, but he didn't. He said that he wants to see me early next week and not to wait until the 9th. So I have an appointment with him on Tuesday and he will re-do the errant tests. I am going to ask him to send the results with Dr. B so I don't need to have them done twice.

I'm kind of sad about the spironolactone. I hoped I could tolerate the dosage, but that just isn't the case. At least we gave it a try and there were plenty of watchful eyes to make sure that it was done in a safe way. Spironolactone comes in a topical form and I'm going to ask if that is a safe possibility, but I doubt he'd be willing to push my luck a second time.

Sometimes I feel like my health is a never ending carnival game of gophers. I stomp one condition or syndrome back into it's  hole only to have another one of those little devils pop up somewhere else. I sometimes wonder why I try. Sometimes I understand why other people don't.

Lessons learned:
1. Dr R is a very smart doctor and I'm glad that he's cautious.
2. Patently ignore any future suggestion that I restrict salt in my diet

How it wears away

I have a budget. It had this week being an easy one.  It should be an easy one. But last week my brakes started to squeel and grind. I knew I needed new pads, and probably both. I was right, but my brother is handy. I was able to get the job done for the price of parts. Not bad. But when we were going  to leave to get the parts, I tried to start my car. No go...the battery was completely dead. I thought it was going to die a year ago, but I have limped along on it. Saturday it was completely dead. I had to get a new one...so much for the wiggle room in my week. Not to worry, I still would be alright...I think...So went the logic. But then a bill that I needed to pay was a bit higher than I expected...don't panic. Things are still getting paid. You have money to eat, and a full tank of gas. Still the balloon is a little closer to danger.Then she calls. Student loans aren't going as we calculated. It will be paid, but their will be no living expenses. Suddenly I'm worried because one of my chicklets is out of the nest and has no wings to fly. I have X amount, and I will halve it with her. She has to have food! So now I'm looking at the week (again) and thinking, I can pay this and have this amount and that will last so long and if only the hscs draft will come in. Oh well, if time has taught me nothing it is that hard times are passing...We will both survive.

Founders Day Cake

It's Founder's Day here at the Big Brown shipping company. Last year our representatives from one of the agencies that we use came by with chocolate cupcakes just as I was signing my son and grandson in the building. They gave him one and he immediately planted it into his face. It was hysterical. I wish I had a video of it. They came by today with a smaller version of the cupcakes from last year. If Jack were here I'd give him this one to see if he'd face plant it again.

This is why you are fat

 

Low Carbing?

My Desk Today

It's getting a bit colorful in here today.

Sorry

Sorry about the post below. I was tired and cranky.

So, it's my birthday

So it's my birthday again and someone Facebooked me to tell me that I was turning 29...Ha ha ha, isn't it cute. The truth is that since I didn't die by the age of 47, 54 means that I succeeded. My room mate from college unfriended me because I chided her for dehumanizing cancer patients with an update that read  "Cancer patients only want one thing". No, our lives don't get put on hold because we have cancer. I wanted my children to not be traumatized by this experience. I wanted to go to Matt's wedding. I wanted to be included in the invitation to go to lunch and a movie with my girlfriends...I wanted  a normal life that everyone around me saw as impossible due to my circumstances. My needs weren't as simple as my room mate would have liked. So she unfriended me. Should I care? I am tired of being marginalized by everyone who thinks they know what I want or what is best. I had cancer, not a lobotomy...and I suspect that even those people who had a lobotomy are tired of being marginalized. I'm happy that I am turning 54. It beats the hell out of the alternative.

Grand Rounds is Up

An article from this blog made Grand Rounds this week at Dr. Pullen.com's medical blog.  Check out Grand Rounds Vol. 7 # 47 to see the best of the medical blog posts of the last week.

Well now, that's interesting

House mail received today

Umm, building 2 only has 4 floors.

On second thought it only has 3. Levels 1 and 2 are the cafeteria.

Saturday Morning is Great!

I went to see Dr. B this morning. I knew that I was down a few pounds and I am down 3.5 pounds. So yeah me, I love it when the doctor knows that I'm trying. I have now lost 34 pounds. But my blood pressure was down a bit. I'm hoping that it was just a good time to check and not indicating that the spironolactone may be too much for me. Dr. B wants another round of lab work, so I will be looking for a Lab Core around here.

I knew that Lizzie was on her way home, so I called after the appointment to see if she wanted to get breakfast with me. She did so we headed to Cracker Barrel. While we were there we had a wonderful conversation. I have really missed conversations with her.

Lizzie needed to pick up a few things, so we went to Walmart. As we were walking in the greeter told me that he liked my new hairstyle. Something about that creeped both Lizzie and me out. I guess I go to Walmart too much if the greeters recognize me. We walked around for a few hours and then hung out at Starbucks drinking an orange mango smoothie for me and iced coffee for her. Hey! don't judge, those smoothies only have 250 calories and they are packed full of nutrition and they have 15 grams of non-meat protein. Plus, it is cold and I don't want hot in a Georgia summer. Not that I ever drink coffee, I'm allergic to it...really I am.

Lizzie had a "date" with her best friend at 5:30 so we came back to the house in time for her to get a bath and wash her hair. After she left, I was hot and sticky and tired of sweating in the heat. I went back to Starbucks to enjoy the air conditioning. On the record, we have effective air conditioning in my house but we have chosen not to use it this summer. We have 2 room units going, but the large unit often gave us electric bills over $700 a month last year. We all would rather spend that money on other things. I personally am spending that money on upgrading mine and my sister's wardrobes. besides, the two rooms that aren't being effected by the window units aren't used during the day. Unfortunately, the rooms are Lizzie's and my bedrooms.

Lizzie came home from her date and told me that she was going to hang out with "the gang" and I know how much they miss her, I missed her too. So I'm not too unwilling to share her even though I would like her to be spending time with me.

So, I have Lizzie back for a short time. She starts college next week. She won't be so far from me. She's only going down into the city. She will be home on weekends. It's just that I know that soon she will be gone from me just like the boys are.

But yeah me! I've lost 34 pounds...

Dr. R this morning

I have a post from the weekend that I would still like to work on, but today was kind of good. It makes me know that for all the reservations I had about my primary care doctor, he is the right one for me. For the first time ever, I asked a doctor to increase my medication. I usually allow them to choose what medication I need to be on and what dosage. However, the dose of spironolactone that I take is eight times too low for the ideal dose I need to treat alopecia. I am not completely comfortable with the idea of taking that much of the drug. But I am also not comfortable with doing less than everything possible to stop and maybe reverse my hair loss. Especially since yesterday Dr. P was talking about the possibility of doing hair transplants in a year. The idea horrifies me.

Dr. R listened to me and looked at the biopsy report. Then he suggested that we start off taking 50 mg twice a day for a month. Then checking my blood pressure and potassium levels to see if it would be safe for me to continue taking that much of the drug. He said he would consider slowly raising the dosage if I was tolerating it well. It is a great plan. I was concerned about both of those issues myself. So now I know I have a doctor who is willing to listen and work with me. Feels pretty good.

Where I've been this weekend

Jack playing hide and seek

Jack hit a happy milestone this week. It has been a year since he had a bleed.  Yeah Jack! Quite an accomplishment for a three year old who produces less than one percent of the factor 8 required for blood clotting. We had a party that included low carb sugar free cupcakes. After the party we went out to a restaurant called Uncle Nicks Smokehouse. What a feast! We ate on the patio that overlooks the lake, which was beautiful. We ordered the Family Feast which included a rack and a half of ribs a whole chicken, cut up, smoked sausage, brisket and shredded pork, with two sides. We had cole slaw and steamed vegetables. Jalapeno corn muffins are served with every meal. This meal was touted to feed 4. The four of us ate this (Jack may be small,but believe me, he can eat with the best of them.) and Tim and Jenn took enough food home to eat for another two or three meals. And the price on that feast, an incredible $45. It was amazing. After dinner we went down to relax near the lake. That was when Jack decided that we should play hide and seek. He covered his eyes with his hands and walked around counting to ten. I was so relieved when he didn't walk into a tree.  On Sunday I was able to take him to see Winnie the Pooh. He hadn't been to a theater much and was thrilled with the movie. So nice to do something with him that he enjoyed.

And that's when my head exploded

The drama of the dermatologists office visit finally ended today. On Monday around 3:00 I realized that Jan never got back to me regarding the biopsy report so I called Dr. Fs' office again and asked for Jan. They put her on the phone. She sounded very discouraging about getting the report. But I didn't let that stop me. She faxed me a release of information form and told me that Dr. K would have to sign off on it before the report could be faxed. She also said that Dr. K wouldn't be in the office until Tuesday.I signed and faxed the form back to her very displeased that I was having to wait another day for the report.  On Tuesday afternoon I called Jan because I still hadn't gotten the report. She told me that Dr. K takes them home at night and signs them, she'd fax the report in the morning. I wasn't a happy camper,  but I didn't complain. I waited all day Wednesday for the report, but when it passed 3:30 I decided to give her another call. Jan told me that she had forgotten that Dr. K. had the day off, but she would fax the report in the morning. Unbelievable! If the whole appointment hadn't been so weird, I wouldn't be as uncomfortable with that answer as I was. Still, I was nice about it. Today at 9:00 I called Jan to make sure she would send the report. Jan was on the phone with someone else. I left a message in her voicemail box. At noon I called back and was again told that Jan was on the phone with someone else, but I declined to leave another message. Why should I, it is obvious that Jan does not return phone calls. Instead I decided to pay a visit to the office. When I got there I introduced myself and told them I had been trying to get a copy of my report since Friday, and I was there to pick one up. The receptionist went back to ask Jan about the report and came back to tell me that Jan said that Dr. K had not given her the signed form. I said fine, then I wanted to see the report. At this point, I wasn't  really sure the report existed. But I was sure that according to HIPAA laws the office had to show me the report or be in violation. That is when Jan decided to go get the signed request and give me the report. She apologised, and I said thank you and left.

For all that drama, the report didn't say anything but androgenetic alopecia, no fungus's or inflamation or stress related hair loss. I'm in the early stages of alopecia, so that means that there is a better chance for regrowth if I can get on effective treatments. I'm already doing all the over the counter treatments. I have an appointment with Dr. R to discuss the possibility of increasing my spironolactone dosages. I really don't have much hope that he's going to be willing to do that. If he doesn't want to, I can ask Dr. C to do it.  He has already said that taking up to 100 mgs would be safe and that he has some patients taking as much as 800 mgs. He is also not concerned that my potassium would go to high. We work hard to keep it up to near normal levels. Still, he may not want to treat hair loss.

So, here I am. Knocking on the door of crazy again. Oh, and I have an appointment with Dr. P on Tuesday for a skin check.... What do I say to Dr. P about strong arming his staff?