Update: Hormones

I have an update following my recent appointment with Joanie. She reviewed my hormone level lab results which tested my Progesterone, Testosterone and Estrogen levels.  I forgot to ask for a copy of my labs for my records, so I cannot provide the reference ranges right now, but I do remember most of the information:

Luteal Phase (time of my cycle when labs were drawn)

Estrogen: high end of the reference range

Testosterone: normal range

Progesterone: lowest possible number on the reference range

I have been taking bio-identical progesterone since April of last year, without it I don’t know if I my levels would even be on the chart! Obviously my progesterone levels continue to be extremely low and my estrogen levels very high. I am hopeful that as I continue on Armour and continue to heal my adrenals that my body will be able to naturally refuel my deficient hormone levels.

It is no wonder that I have not been able to carry a pregnancy with such low levels of progesterone.  I am left to wonder if my body will ever heal itself in such a way that I can support a pregnancy naturally. This is one of the many questions I have for Joanie in a few weeks.

I have increased my zinc to 2,000 mg a day and Joanie has added Morinda Supreme to my regime again as my Candida continues to rear its ugly head.  I have also started to have some small rash breakouts on my skin.  When I showed the rash on my leg to Joanie she said immediately that it is likely the Candida.  She wrote a prescription for an antifungal cream and I left her office totally grossed out at myself. 

She also referred me to a new chiropractor and I will be calling to schedule an appointment soon. I think that is it for now. I have updated my treatment page.

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Good Things

I have waited to write any updates until I believed that the changes I felt were real and a sign that I am making progress.  I think I’m ready to fill you in and will have a post up very soon. 

Until then I have updated my treatment page from my appointment this morning with Joanie. 

It’s good, my friends.

ThyroidChange.org

In “real life” I work as an Advocate for severely wounded, ill and injured Soldiers who were medically retired as a result of their service connected injuries and conditions. I wear a lot of hats in this job, but one of my primary duties is to make sure that the medical needs of the Veterans I work for are being addressed and they are receiving the care they need. I will do what it takes to make sure the voice of the Veteran, their spouse or caregiver, is heard by medical professionals responsible for their care. Even if this means sitting in a medical appointment to ensure the Veteran has a chance to give feedback and ask the questions they want answers for.

I am often amazed at how annoyed and short the Doctors are with their patients when they try to share how medications they are on have increased symptoms, not helped, etc. For those who struggle with memory loss related to Traumatic Brain Injury (TBI) they often take a little longer to formulate their questions and this seems to frustrate some Doctors which increases the anxiety of the patient. If I am in the appointment I can help the Veteran remember the questions they have so they are not rushed out the door. I am professional and respectful in my work, but there are a few Doctors who avoid eye contact with me in the halls following these encounters. I choose to take this as a sign I’m doing my job for the Veteran. 🙂 This isn’t my experience with all the Doctors I work with, there are many who are very dedicated to their profession and to the population they serve. 

All this to say, it is no surprise to me that many thyroid patients report struggling to find Doctors who will listen to their health history and symptoms and are willing to examine the link between many common symptoms (like depression, anxiety, unexplained weight gain, fatigue) and thyroid and autoimmune disorders. 

Recently, I was invited by ThyroidChange.org to join a community of bloggers who are sharing their health journey. I made contact with the founders to make sure they understood that at this time, thyroid issues had been ruled out in my case, but they still wished to include this blog on their “Member” page. 

You can read more about the mission of ThyoidChange and different thyroid patients experience here: patientexperience.com

I am also including information from the ThyroidChange website:

ThyroidChange, a web-based initiative, unifies the international thyroid community (patients, organizations, groups, blogs, websites and physicians) and mainstreams the voice of thyroid patients who are left symptomatic and not being assessed or treated with current options.  Our global network will empower the individual patient with access to credible, current knowledge. Our success will increase thyroid disease awareness and future research.

ThyroidChange supports existing and future thyroid advocacy efforts with the strength of a united global thyroid community. By informing members of current initiatives within our community, it stimulates mutual collaboration for our shared common goal for change. Individual patients will find support and opportunities to self-advocate.

ThyroidChange facilitates the achievement of our goal: increased thyroid patient access to current assessment and treatment options and therefore, optimal thyroid health. Thyroid dysfunction affects 1 in 4 individuals, and can begin at any time. Our advocacy will encompass hyperthyroidism, hypothyroidism, autoimmune thyroid conditions, thyroid cancer and other thyroid issues of concern to our community.

I am honored to be included among the list of other Members. My motivation for changing the focus of this blog was to put my experience out there in case someone found similarities to their own health issues and it helped them find the treatment they need. I hope that this platform will get my story out to more people who can benefit from it.

You can find my blog, bluebirdthriving, on the Members page at ThyroidChange.com. While you are there, please read and consider signing the petition.

Today’s post, brought to you by the Vitamin E and Omega 3

Last week I saw my NP to see how I was doing on the adrenal meds since she will be gone for the whole month of September.  I’m going to start calling her by name, because she is an actual person and is a critical part of my journey so it feels strange to not use her name. 

So, here you go: Her name is Joanie and she is well on her way to becoming one of my favorite people, not just because she helps me feel alive and human.  I find her to be the kind of person who looks for joy in all things and you can’t help but be drawn to the energy she gives out.  I am so grateful I stumbled across her name and clinic.

We discussed several things during my appointment: 

Hydrocort: increased dose from 7.5 mg a day to 12 mg a day.  Now I take 7.5 mg am, 2.5 mg noon, 2.5 mg 4pm.

I was still experiencing the afternoon/evening crash on the 7.5 mg dose and in the last week since I increased to 12 mg I can definitely feel a difference in my energy during the 5-9 pm hours. I really noticed this yesterday when my husband and I were at a store.  On the drive home I glanced at the clock and was amazed to see it was almost 8 pm and I still felt pretty alert and alive.  Amazing.

When I do get tired, I still crash pretty quickly, so I have no plans to try my luck and stay out past 8:30/9. 

I’m such a party animal. Zzzzzzzzzzzz.

Ashwaganda Adrenal Adaptor: Now I take one capsules in the morning and one at night before I go to bed.  This is to try to extend my adrenal support during sleeping hours in hopes that morning won’t be so miserable for me.  I’m nowhere near “morning person” levels, but I have noticed the last few mornings I do feel more rested when I wake up.

Magnesium: I was taking 400 mg magnesium after breakfast with the rest of my supplements, but according to muscle testing results during my appointment, my body indicates needing this in the afternoon.  Now I take it with my 4 pm Hydrocort dose.

Flax Oil and Vitamin E: I have added Flax Oil (Omega 3) and Vitamin E to my daily regime.  This is related to the ongoing process of healing my “leaky” gut.  I have been struggling with stomach discomfort even though I have maintained a gluten free diet consistently since it was confirmed I am gluten intolerant.  It’s very strange to think about the fact that my body doesn’t work right and doesn’t get the nutrients it needs even though I feel that I have a pretty good awareness of a healthy diet.  It’s frustrating because I don’t show any results of my eating habits.  My hope is that if my energy levels continue to improve and I take the time needed to strengthen my adrenals I can return to a fitness routine, which may help my metabolism but as it is now, I’ve be instructed to avoid starting anything strenuous.  “Relaxing walks and gentle yoga” are about the only approved activities for me at this time.

I take 1 tablespoon of flax oil in fresh “green” juice I make at home with my juicer.  I decided to start juicing vegetables again at home to help my body absorb them easier than eating raw veggies because my body has to work harder to break them down. 

After discussing all my med and supplement changes our conversation turned to the always pressing issue on my mind.  I asked her what she felt was a realistic time frame to consider trying for a baby.  Her response: “Let’s stay on our current track and see where we are in a year.”  This isn’t what I hoped to hear, but honestly, I expected such.  I don’t feel confident that I have made enough progress to take the risk of trying for another pregnancy right now.  I’m not sure I have the strength to lose another one, although I said that after the second miscarriage too.

There is still a lot of work to do and I believe more will discovered in regards to my fertility issues.  There has been no change to my cycle: 23 days (like clockwork) which, by the way, results in 15-16 cycles a year.  No wonder I’m such a hormonal disaster! It’s like a rollercoaster ride I can’t get off of.  Joanie believes this is because there is a pituitary gland issue. 

On another note, this Friday, August 31, was my due date for the twins I lost in February.  I’m dreading this day as it brings up a lot of emotions for me.  I plan to take it easy and will be focusing on taking care of myself.

I have no other choice.

I love this portrait by Vladimir Volegov.  In my counseling I have been talking a lot about being a mother.  My therapist, Carole, has encouraged me to work on embracing this part of me. It is a difficult place for me to go, but this helps me picture myself as a mother. When I look at it I feel some peace. Maybe even a little joy.

Vladimir Volegov

“She was a genius of sadness, immersing herself in it, separating its numerous strands, appreciating its subtle nuances. She was a prism through which sadness could be divided into its infinite spectrum.” ― Jonathan Safran Foer, “Everything is Illuminated”

Progress

A lot has happened in the month of August so far, and it’s still early in the month.  I have a lot to cover in this post.

Before I dive in, let me review the last few months.

In April I met my NP and discussed my health history and symptoms.  She ordered blood work which looked at everything: TSH, Free T-3 and T-4 and Reverse T-3, Iron, B12, Vitamin D. Pretty much a laundry list of things. I changed my diet by eliminating dairy, gluten and simple carbs from my diet, started a probiotic and Morinda Supreme as she diagnosed me with candida and “leaky gut”.  I know, that just sounds gross, and it really is. 

If there is one thing I learned quickly, it’s that your guts have A LOT to do with how you feel.

There was a delay at the lab and so my results took twice as long to get back. When I met with her in late May, at that time, my blood lab results were “relatively good” and she determined that I was not hypothyroid just really stressed and low in my Vitamin B’s and Vitamin D.  She did agree to start me on Lugol’s Iodine solution (6 drops, daily) to see if that would help my fatigue, anxiety, weight, etc when I pressed her for an explanation as to why I felt so drained and agitated all the time and my temperatures were low.  She also increased my B Complex, and Vitamin D3. 

Over the next few weeks, I did notice a subtle improvement in my energy (any improvement was noticeable) but I still struggled with nearly constant anxiety and all the fun stuff that comes with that: avoidance, irritability, exhaustion. 

It was a really discouraging couple of months.  I expected that my blood work would have bright flashing hazard lights indicating thyroid issues and it was a huge let down when that didn’t happen but my symptoms persisted.

I was encouraged by my husband to continue to look for help for my anxiety and depression and so I entered counseling to help me process everything that was going on: my grief from the pregnancy losses, my health, my vocation, the challenges I experience daily just getting out of bed.  All along I have said that I just want to be healthy and find out what the problem is. I am willing to recognize that the last few years certainly justify feeling depressed and I am not a stranger to the benefits of counseling as I have found great healing and renewal through this process in years past. 

It’s work, though!  Whew!

So far, counseling has brought me some great insight and my therapist  is a very kind and genuine woman.  Her office is my safe haven where it’s all about me and I can let out all my thoughts my complaints and frustrations. It’s also a place where I learn new ways of coping and looking at things. I am committed to working on my whole self: body, mind and spirit.

In July, my husband, who is also treated at the clinic I go to, had an opportunity to mention to my provider what he sees me struggle with and she told him that we should do a saliva test to check for Adrenal Fatigue.  I had an appointment with her the following week and we agreed to do the test. 

On August 1st I had an appointment to find out the results from the saliva test.  Before she started to explain she looked at me and said, “I don’t know how you get out of bed in the morning.” I chuckled and said, “Well, it’s not pretty.”

Trust me. It isn’t.

I have been reading a lot about adrenal function and cortisol.  As I understand it, cortisol is one of the hormones the adrenal glands release to prepare us for challenges, including “fight or flight” situations. Cortisol, also known as a “stress hormone,” works by increasing blood pressure and blood sugar (for energy). These are helpful physiological responses in the heat of a stressful situation, but if they continue throughout much of the day, weeks or years, the body will suffer. Sustained levels of cortisol can destroy healthy muscle and bone, slow down healing and cell regeneration, disrupt metabolism and digestion, and compromise your immune system.

To help me explain my results, I took a picture of the graph that shows my “Circadian Cortisol Profile:”

image

 

The light grey shadow you see is considered normal range.  As you can see, I start the morning out low and just keep crashing.  Even though I am considered normal range by 4pm and midnight, she explained that I am still so low for “normal”.  I struggle throughout the day with energy, my anxiety is highest in the morning and then I feel more fatigued through the afternoon and evening.  I wouldn’t consider the way I feel as normal, either.

The saliva test also tested my Cortisol-DHEA Correlation. My results are in the picture below:

  
image

In order to explain this accurately, I’m going to refer you to this link: DHEA and Adrenal Imbalance, by Marcelle Pick, OB/GYN NP

Results showed I am in what is considered “Zone- 4- Maladapted Phase II”.  I’m just going to quote directly from my lab paperwork: (this) “represents a marginal cortisol output with reduced DHEA levels reflecting a limited adrenal response…this suboptimal response is any response not consistent with a normal diurnal cortisol production pattern.  This condition is usually the outcome of chronic and protracted stress exposure.” 

Uh, yeah!

A surprising result from this test was that I was found to be positive for Gliadin Ab, or Gluten Intolerance.  Borderline range for this lab was 13-15 U/ml.

A positive result is anything greater than 15/mil. 

My result was 32 U/mil which was described to me as moderate to severe gluten intolerance. 

I was surprised to learn this, although it made a lot of sense as to why I felt better when I consistently eliminate gluten. 

I think that this has been the slowest realization to sink in because I am faced with challenges every day.  I find myself repeating “I am gluten intolerant. When I eat gluten, my intestines are inflamed and my body doesn’t absorb nutrients I need.” 

I have read a lot about gluten over the last 2 years, where it hides and how to cook most “normal” things without it, so I’m not completely at a loss.  My greatest challenges are being prepared and holding the boundary when others I am with don’t have this issue.  At least now I have a medically diagnosed reason to be gluten-free.

I guess it feels more “official” and helps me feel justified when I explain it to people.

Adrenal Treatment:

I already updated my treatment page a few days ago, but let me explain in detail. Our plan to strengthen the adrenals involves taking Hydrocort at specific times throughout the day. I am working up to 7.5 mg (5 mg am, 2.5 mg at noon).

My NP has not prescribed DHEA support at this time as she wanted to see how I respond to the Hydrocort.  She also prescribed a supplement called Ashwaganda, an adrenal adaptogen that I also take in the am and at noon.

I started this medication just over a week ago and I am still building up to the full dosage.  I still feel extremely tired, but I can say I have noticed a lot of improvement in my anxiety, especially in the morning.  I definitely still feel anxious, but it’s more subdued than a week ago.  I am hoping that my energy improves over the next few weeks too. 

I’ll leave it at that for now. 

I still want to talk about what I have to teach myself about adrenal fatigue, fertility and how to effectively treat myself but I will save that for another post. 

I also have some very important information about thyroidchange.org, but I want to give it my full attention so I’m saving that for my next post coming soon.

Here I talk about cheese and spitting. Try to contain your excitement.

I saw my NP about a week and a half ago and I have a couple of updates:

I was pleased to learn that my diet and the Morinda Supreme capsules have helped my body start to heal internally, and I am trying my best to keep up with the food changes.  I don’t quite know what to call my diet.  Probably the “Can’t Eat That” diet sums it up best. This is difficult to do some days when I am just exhausted have nothing handy in the refrigerator to throw together and I know it would be so easy to call the pizza guy. 

Some days I stumble. My vices:  Red vines.  Margaritas.  Cheese.

 Oh, I miss cheese.

Especially when I am tired, or amped up with anxiety or knocked out by the summer heat on my drive home in my cranky car with the lukewarm AC.  And I slip knowing that I will very quickly start to feel even worse. 

I like to think it would be so much easier if I didn’t have an office to go to 40 hours a week, which is true, but it really boils down to being intentional with my time and planning ahead for days like that.  It may sound like an excuse, but maybe one of you reading will understand when I say that it’s hard to muster up extra energy to pre-cook freezer meals.  Of course, that’s if I remember in the first place.

I’m working on that.

This week I took a Saliva test to check for Adrenal Fatigue.  I actually have my wonderful husband to thank for advocating for me when he had an opportunity to speak with my NP.  He was able to share what he sees regarding my struggles and she listened to him! 

I love how he loves me.

I was already aware of this, but when I met with her in my appointment she explained that many of the symptoms of hypothyroidism and adrenal fatigue are the same and if there is adrenal fatigue there may also be underlying thyroid issues.  She said that a saliva test is the most accurate way to test hormone levels.  You can read more about why here.

She ordered a saliva test for me to complete and send to the lab.  It was very strange; I had to (literally) spit into 4 vials 4 times during the day: morning, noon, afternoon and midnight and then send it directly to the lab the next morning.  I am hoping these results won’t take as long as my blood tests.

 I have updated my Treatment page as well.  I have decreased my iodine and I am taking Vitamin C and Zinc. 

I take a freakish amount of supplements.