In May 2018 I was short of breath. I thought I might have pneumonia. Turned out they found a pulmonary embolism and I spent 4 days in ICU. I was finally discharged to go home and rest. This also came shortly after a kidney stone and high blood pressure diagnosis, and I was really, really, tired.
But my lung capacity, while better than with the PE, still sucks. “It takes time to recover from a PE”. Uh-huh. Also I was busy trying to hit deadlines at work, despite being tired all the time, and I only had so much time and energy to deal with crap. So I didn’t push to hard on why my lung capacity is still smaller than normal.
It’s over a year later. I still get short of breath trying to walk any distance. Slowing down helps but is frustratingly slow. So this week I’m going to the Pulmonary Clinic for lung capacity testing! Good! And to find out my unmedicated state, I’m not taking asthma meds and anthistamines for a day beforehand!
Oof.
“You can use a rescue inhaler like albuterol if needed up to 4 hours before the appointment.”
Uh, right.
What really worries me is that I’ll end up itching. I did confirm I can use topical meds, like hydrocortisone cream or antihistamine eyedrops. I may be focusing on itching to avoid thinking about shortness of breath. But still. No Zyrtec. Eek.
As many women know, hand washing of bras is recommended to keep them in good condition. This is not necessarily a huge burden!
Hand washing of pantyhose is also recommended. Thank heavens I don’t have to wear pantyhose.
And then came…compression stockings.
Compression stockings drying on towel bar
Compression stockings are often recommended for people who are on their feet all the time, who are flying, who have had lymph nodes removed, and to prevent blood clots.
In my case, I eventually realized that part of my left knee pain was actually located below my left knee. Where there was also swelling, and which felt better if I wore tight leggings. My ARNP diagnosed likely blood flow issues and varicose veins, and referred me to a vascular specialist.
The vascular team did an ultrasound of the veins in my leg. Leg veins have one-way valves which supposed to keep the blood going up my leg, back to the heart. It was confirmed that my valves are not all working well. In particular, the one-way valve just below the knee on my left leg – where I had swelling and pain – wasn’t really one-way anymore. Compression was recommended to reduce the swelling and help the vein to move the blood to the heart where it belongs.
I didn’t realize at the time that this would mean the hand wash only laundry would never end.
I was prescribed 20-30mmHg, knee-high stockings. The mmHg is “millimeters of mercury” pressure, and 20-30 is about middle of the range. I did go to a medical supply store to get fitted. I recommend it since you can get some knowledgeable advice on fitting and how to put them on without putting a fingernail through them. If you wear a common size you may be able to wear them home. My size 14-16 friend got fitted with thigh-highs after her cancer surgery and wore them home.
Initially I didn’t fit anything over-the-counter due to the swelling in my calves; after wearing leggings daily for a week, the swelling reduced enough that I could wear a standard size instead of custom made. I wear Juzo Max knee-high stockings, which have more of a flare at the top of the calf than the standard knee highs, and which wasn’t in stock but could be ordered. I also pop for the “silicone band” of little silicone beads to keep them up.
Pros:
No below-the-knee pain.
Much less swelling in calves.
Legs feel less tired.
Cons:
Stockings are expensive (mine are $78.39 per pair).
Stockings require hand washing.
Stockings need replacing every N months. Currently N is 2 or 3 months. I know folks who go 6 months, others who buy them monthly.
None of my leggings fit right anymore.
All that said, the compression stockings have been a really positive thing for me. The below-the-knee pain is gone. Walking is more comfortable. I still elevate my feet whenever possible, but my legs and ankles aren’t swelling every evening. These are all terrific.
I’ve written before about being deficient in Vitamin B12, so you may understand that this is a bit closer to home for me that others. And the endocrinologist has reminded me many times that I’m insulin resistant.
[Note: Includes discussion of weight loss and history of intentional weight loss. Please avoid if you don’t want to read it.]
Visited the endocrinologist again to follow up on my med changes. On my way into the office, the doc asks how the meds have made me feel; I said that I haven’t noticed much change except my step counter says I’m walking more. She weighs me and happily congratulates me for losing 8 pounds in a month. I mumbled something like “Uh huh” and we moved onto the rest of the appointment.
The doctor’s congratulations brought up feelings that I didn’t try to unpack during the appointment. After the appointment I began to think about it, and why it upset me.
First: Why congratulate me? I haven’t changed my eating habits. I haven’t been counting calories, or carbs, or points, or anything that I would normally do when I’ve intentionally tried to lose weight. I have been a bit more active, but I’ve been MUCH more active in the past without losing weight. This is not something I have made or built or achieved.
Second: I got a silver Translator badge in Ingress this week, in part because I had energy to walk around playing the game. This is good.
Third: There have been times in the past when I was trying very hard to lose weight, and lost weight, and felt like I’d won something. I reveled in congratulations and people’s happiness. Right now? I feel like a bystander.
Fourth: There have been times in the past when I was trying very hard to lose weight and didn’t. I followed the diets. I’d do the exercises. And, despite doing it all “correctly,” I did not lose weight. Did I get congratulated on my effort then? Nope. I’d be blamed. I’ve been told I was not measuring correctly, or I should use a scale, or a different diet, or more exercise. I’ve been told I was lying about my intake and exercise, because I “couldn’t” not be losing weight if I was really eating and exercising like I said.
Fifth: Maybe I was a bystander before, too.
Sixth: I’ve been trying to build my arms up for the next higher weight dumbbells but noooo, body has other plans….
So, I guess I’m having some feelings here.
Finally, I reminded myself that the reason I pursued treating my borderline hypothyroid (which led to seeing an endocrinologist etc) is to feel better and have more energy. That my weight went up about 30lbs in the last few years without a change in eating habits is one of my symptoms; my weight may change as part of correcting it. It’s OK to be a bystander here.
Tonight I tried out some shoes from Zappos on the treadmill and this Mary Lambert song came on.
We are, we are more than our scars.
We are, we are more than the sum of our parts.
— Mary Lambert, “Sum Of Our Parts (Alternate Version)”
I started taking levothyroxine this fall, and got the standard spiel from the pharmacist:
Take first thing in the morning.
Do not eat anything else for 30 to 60 minutes after, including other oral medication.
Do not take with calcium or iron supplements for 4 hours after taking levothyroxine.
“You CAN have coffee!” the pharmacist chirped happily. I was happier when she confirmed I could have my inhaled asthma meds.
This has been an adjustment. I was concerned it would bring up the anger-rebellion response I usually have had when dieting for weight loss. As it turns out, it hasn’t. This has probably been helped by the fact that this is about a medication which has been showing direct benefits ever since I started taking it.
It also resulted in me forgetting the rest of my morning pills once or twice. Fortunately the vitamin B12 and D I can miss occasionally, but the SSRI can be dangerous if I stop it abruptly. Having a weekly pillbox helps me to know whether I’ve taken them.
I did take the “no calcium or iron supplements” a bit to the extreme by also skipping dairy and meat for 4 hours, which created the concept of “dairy o’clock” for me. I have gradually relaxed that, but continue to adhere to the much more important “no food or meds for an hour”. I have a Detachable Pill Box which I can use to take my other morning pills with me to work if I need to leave before I can take them.
In the first month I took levothyroxine, I felt that I had more energy. According to my step counter, I walked more. Also important is that my focus improved; I was able to complete tasks at work in less time than before. And according to the scale at the endocrinologist’s office I lost 3lbs.
The endocrinologist seemed extremely pleased by the 3lbs. I tried not to pooh-pooh her parade by pointing out that it’s less than 1% of my weight, but damn, I was much more focused on the “able to get more work done” and “able to walk more” parts of the equation.
A comment for Treat Weight First? that I did not approve, but found striking for its ability to completely misunderstand, was:
There must be some powerful drugs in that koolaid you’re drinking. You admit you are morbidly obese, you have multiple health problems directly related to obesity, yet you shun the doctors that are trying to help you and others like you to lose weight. Amazing!
(Why? Combine a rare condition with an expensive, injectable drug treatment and you get fun “Who’s on First?” times with the doctor, insurer, pharmacy, and the drug manufacturer. I am not thrilled to have the drug manufacturer’s help line in my cellphone contact list. On the other hand, I do have the drug manufacturer’s help line in my cellphone contact list.)
A higher level of body fat, especially around the waist (Like the 30lbs I gained since my dad died? Or the 50lbs between 97 and 2001? Or, er, my entire life?)
Anxiety and Depression (I didn’t have a problem with anxiety until about 4 years ago. Uh…)
Fatigue (So, not just hypothyroid?)
Feelings of being isolated from other people (So…not just getting older and less patient?)
Greater sensitivity to heat and cold (So… not just getting older or hypothyroid?)
Less muscle (lean body mass) (Yeah, my weight lifting hasn’t had results it used to, it’s harder to build muscle…)
Less strength, stamina and ability to exercise without taking a rest (Like how I could walk a mile a few years ago and now I need to rest after a couple blocks? YES IT’S VERY NICE TO KNOW WHY.)
And a symptom that’s very, very scary for me: hypothyroid can cause impaired memory.
So let’s go back to that “koolaid” I’m drinking. And about how weight loss is going to “help” me. Because weight loss will obviously fix the “obesity-related” health problems I have. Except, wait — those hormonal deficiencies are “obesity-related” in terms of “people who have this tend to be fat”, not “caused by fat”. And they’re screwing up my life.
Weight loss isn’t going to fix hormone deficiencies.
Weight loss drugs won’t fix hormone deficiencies.
Weight loss surgery won’t fix hormone deficiencies.
If I were to lose weight without treating those hormone deficiencies? My quality of life would not be improved. FUCK THAT. Or, to be precise I am going to continue to focus on improving my HEALTH. Because THAT will improve my life.
(How RUDE to put MY priorities first!)
And if, in the course of improving my quality of life — things like restoring my former energy levels (horrors!) and my former stamina (eek!) and regrow my muscle mass (Aack!) and reduce my anxiety and depression (gasp!) — I may end up losing some weight? That’s up to my body.
Objective: To formulate clinical practice guidelines for pharmacological management of obesity.
That’s the goal here. That tells you what this is primarily about: weight-loss drugs. Two more were approved in 2014, at least in the US – Europe has been slower to approve the drugs.
There are a few things in the guidelines that I like.
First: Some medications have weight gain as a side effect. I consider this is a useful fact for medical practitioners. It makes no sense to prescribe a drug that has weight gain as a side affect and then chastise patients for the resulting weight gain.
Second: Yes, it makes sense for medical practitioners to be aware that medications can cause weight gain or loss, and to discuss that with patients. A fat patient may prefer a drug that doesn’t cause weight gain. A slender patient may want to avoid drugs that cause weight loss.
Third: They’re measuring that a weight loss drug is “effective” if the patient loses 5% or more of their body weight in 3 months. If that seems low? Yes, yes it is. Worth anal leakage? I think not.
Fourth:
Historically, patients and providers thought that weight loss medications could be used to produce an initial weight loss that could subsequently be sustained by behavioral means. The available evidence does not support this view.
This is an important admission. The human body doesn’t like to have its weight set point messed with.
The things I disagree with? It’s hard to limit myself to just a few, but:
I disagree that patients need to be moved from drugs that control chronic health conditions just because the drug may cause weight gain. What are the side effects of the new drug? Is it as effective? Does the patient have support during the transition? That matters too — especially with psychiatric meds.
I disagree that patients should postpone treating conditions like hypertension until they lose weight. If the patient wants to try lifestyle changes first, fine — but it should NOT be under duress. The medical profession is already known to mistreat fat people. This can become another justification.
On the flip side, I was prescribed a drug that can cause weight loss (Levothyroxine) this fall. The endocrinologist was thrilled that I lost 3lbs after a few weeks of taking the drug. I don’t care about that. I care about FEELING BETTER. Obviously I’m un-American.
Turns out I’m deficient in human growth hormone. This may explain why I have less strength, stamina, and endurance than I used to have. I have met with my doc to discuss treatment, and am starting it soon. I’m not sure how long it will take to show improvement.
I am finding that having hormone deficiencies that cause fatigue, muscle loss, anxiety, and depression can be similar to simply having depression in that it’s hard to get help when you’re fatigued and depressed. Especially when the deficiencies came on relatively slowly and gradually.
There will be more tests, such as an MRI of my pituitary gland. I’ve got potential posts in my brain about various things related to the tests and new doctors and so on. But right now, it’s still the busiest time of year at work. It gets dark about 4pm every afternoon. At least I know why I’m so tired.
First visit at the endocrinologist to treat hypothyroid. Waiting in the lobby with chairs whose arms are a bit too tight. I am weighed. The doctor asks me to sit on the exam table, so I do – no back support, legs dangling. In taking my medical history she asks about my weight history. After more history, the doctor decides to take my blood pressure. While she wraps the blood pressure cuff around my upper arm, she asks why I’m not dieting. We discuss it while she takes the reading. 146/92.
A visit to urgent care for a UTI that may have moved to the kidneys. I’m feverish. The automatic blood pressure reader inflates suddenly enough that the large cuff won’t stay closed on my arm. The nurse insists on using a standard cuff on my forearm. 160-something.
Arrive at my usual nurse practitioner’s office with coffee. Walking, walking. Sit, tech immediately wraps the large cuff around my arm, holds the cuff closed while triggering the automatic blood pressure reader. 138/88.
I finish a slice of toast with peanut butter and a can of diet Pepsi as I arrive at the endocrinologist’s office. I rest 5 or so minutes in the waiting room. Once in the exam room I sit in an armless chair. When the doctor takes my blood pressure, I stay seated, feet on the floor, resting my arm at heart level on the counter, and we both stay silent. 132/82.
You may recall a study from a few years ago about how certain healthy habits — consumption of ≥5 fruits or vegetable/day, regular exercise >12 times/month, moderate alcohol consumption, and not smoking — decreased mortality risk regardless of weight.
You may not have seen this part:
The results of this study reinforce the association between healthy lifestyle habits and decreased mortality risk regardless of baseline BMI. This finding is of great importance to both patients and health care providers, whose perceptions about BMI may lead them to believe only obese and/or overweight patients require regular counseling about lifestyle adjustments. Although the evidence suggests that patients across the BMI spectrum should adhere to a healthy lifestyle to optimize health, many patients with a normal-weight BMI may believe exercise and healthy eating, for example, are less important for them as long as they maintain a low BMI.
I’ve mentioned before that the emphasis on fat often leads thin people to assume they’re healthy. Not necessarily — something the authors called out.
In the pooled analysis that included all individuals in the cohort (normal weight, overweight, and obese), the adoption of each additional healthy habit decreased all-cause mortality between 29% and 85% (Table 2). To put this in perspective, statins decrease all-cause mortality by 12% in individuals at high risk for cardiovascular disease. Given the tremendous benefits of a healthy lifestyle, policies and programs that encourage adherence to healthy lifestyles should be encouraged both locally and at a national level.
PS: I see references to statins a lot. They make money, despite side effects. Not smoking? Doesn’t make money. Exercise can make money, as can selling more fruits & vegetables — but not as much as a drug. Hm.
I had a conversation with a therapy patient of mine recently that spoke volumes to the problems of living in a rape culture that no longer wants to use the dirty word rape. She told me that she and her best friend (both 19-years-old) frequently endured sex with their boyfriends that involved heavy drug use, painful and coerced anal sex, utter boredom for the women, regular transmission of STIs, no orgasms for the women, and “sex on demand” whenever their boyfriends wanted to have sex. When I asked her if she ever felt pleasure during sex, or ever wanted to feel pleasure, she said, point blank, “I thought sex was only supposed to be pleasurable for the guys, right?” Right.
Y’know, romance novels are often seen as pure pulp, but they do groundreadersin theidea ofmutual pleasure.It’s not the worse way to set some expectations for sex. (OK, the “never needing lube” thing can be problem….)
So I threw this on twitter, but I’m repeating it here: I’m 48 years old & it’s been over a year since my last period.
I’m OK with the first. I’m HAPPY about the second — and yes, it means I’m “officially” considered menopausal. I had a few years of skipping periods in the fall & winter, then getting returning to regularity each summer.
I wasn’t entirely sure I was in perimenopause, at first, despite the irregular periods. I would sometimes feel suddenly warm and turn on a fan or ditch my cardigan, but not often. I had problems sleeping and sometimes use ambien, but that was during some major life changes and I didn’t think much of it. After I skipped 6 months I was pretty sure it was the start of menopause — and then I started having periods again. For a few months. And… yeah.
Regularity? What’s that?
I had my first period at age 10. It’s been nearly 40 years. I’m fine with being done.
As mentioned on Twitter, I was at Norwescon this weekend! One of the most delightful parts was the interview session with special guest Seanan McGuire, who is also Mira Grant. I don’t have that to share with you, but I do have this from her book tour last fall for her book Parasite (which IS about genetically engineered parasites, and yes, it’s touched on in the video).
Minute 7 – how having a genetically engineered tapeworm could affect weight loss.
Minute 9:45 – could write a very socially-shaming book along the lines of “now that my PCOS doesn’t prevent me from losing weight, you actually think I deserve decent medical care?”
Minute 11:50 – poop transfers & your personal biome
Minute 25 – on bacteria & how antibiotics are overused
Minute 29 – on how drugs are mislegislated and miscontrolled
Minute 39:55 – on morning person encountering a night person
Minute 42 – “Do you honestly think it’s better to be dead than autistic?”
One of the recent rants I moderated out of the comments included something* about how “wheezing around the block doesn’t count as exercise.”
Wheezing is a symptom of asthma, bronchitis, sinusitis, pneumonia, and other illness. Deciding that wheezing is only due to weight and only will be treated by weight loss is DANGEROUS.
I do wheeze. I have asthma. Now that it is properly treated I can exercise without wheezing. My treatment plan is greatly helped by insurance to cover the not-available-in-generic Advair & other meds. One of my asthma triggers is exercise itself. This means I need to medicate pre-exercise. I’m also affected by things like air pollution and pollen.
If you’re fat and wheezing while walking around the block, you may need to see a doctor about your wheezing. It’s not necessarily “just being fat.” Waiting til you’re thin? A, may not help, and B, YOU COULD DIE in the meantime.
The fat haters of the world would have you believe you only wheeze if you’re fat and should lose weight to cure it. The fat accepters think that if you’re sick, you should be treated for that without having to lose weight first. I’m on the fat accepting side.
*Paraphrased to remove profanity & improve readability.
1am is still Saturday if you haven’t gone to bed yet, right?
Note to self: The expensive twice-daily asthma med works best if the evening dose is 12 hours after the morning dose, not 18 or 20. You carry it with you. Set an alarm on your phone & use it. Don’t just turn it off.
On a personal note, my allergies are bothering me much less since Sunday. Why? I spent over 3 hours Saturday doing “soak, rinse, repeat until the water is clear” on the electrostatic air filters for our furnace. Then waited about 4 hours for them to dry. Fortunately we replaced the windows in a few years back to the inside temp only went down about 10 degrees (and I set the heat UP about 5 degrees before I turned off the furnace to take out the filters).
Also on a personal note, I’m back into the swing of getting allergy shots once a week after an attack of life around November.
Lara Frater wrote about this and I wanted to boost the signal. The Rudd Center recently came out with a study (PDF link) showing that weight stigma affects the stress hormone cortisol.
Exposure to weight-stigmatizing stimuli was associated with greater cortisol reactivity among lean and overweight women. These findings highlight the potentially harmful physiological consequences of exposure to weight stigma.
It doesn’t require being fat to have this kind of reaction, by the way. Both the lean and overweight women “were equally likely to report that they would rather not see obese individuals depicted in a stigmatizing manner in the media.”
It’s not the worse way to set some expectations for sex. (OK, the “never needing lube” thing can be problem….)
(which IS about genetically engineered parasites, and yes, it’s touched on in the video).
