Jan 31, 2010

Sleep delays my life (get up! get up!)

Ever heard the REM song "Get Up"? I am living it right now.

After months of feeling great, the past few days I am like a zombie. I could close my eyes and fall asleep at just about any time. The past few days I had to lie down and take a nap mid-day (about 2 hours) because if I didn't, I was going to fall asleep standing up. It is like a bloody sleep attack.

I'm sleeping well at night, using my "happy light" in the mornings, taking my Synthroid, iron & B12 supplements. I just hate this feeling. I'm all stuffy and congested and sleepy.

The good news is that despite this little setback, my mood is still really good. My thinking is still clear and I'm not in any pain. But yeah, sleep is delaying my life...I wish I could just get up.

Jan 26, 2010

TSH Range - The Saga

How hard can it possibly be to diagnose hypothyroidism? Let me share with you my journey...

Primary Care Physician:
1. Patient books appointment with family doctor to discuss weight gain, heart palpitations & fatigue.
2. Doctor orders TSH test
3. Doctor tells patient that their TSH is within the "normal range" of 0.5 - 5.0 (no mention that TSH has changed from 1.9 to 4.8 since last test
Opinion: advises another TSH test in three months to monitor.

Cranky Internal Medicine Specialist:
1. Meet with patient, treat with skepticism.
2. Decide that a patient with a diagnosis of depression cannot have anything else wrong with them.
3. Note that lab results of TSH at 6.2 are "slightly elevated", but no cause for concern.
Opinion: Patient has history of depression. Depression causes fatigue and weight gain. Refer back to referring psychiatrist.

Private Health Care Physician:
1. Patient presents with weight gain, relentless fatigue, feels lousy.
2. Doctor orders TSH test.
3. Doctor notes that TSH is 8.3
Opinion: Notes that new TSH range is 0.3 to 3.0 - treat immediately, ideal is to be as close to 1.0 as possible

Specialist (Psychiatry)
1. Reviews lab results from Private Doctor
2. Disagrees with the new TSH reference range, but notes that people with depression seem particularly sensitive to thyroid fluctuations.
Opinion: Treat - but not as aggressively as suggested by Private Physician.

Much Nicer Internal Medicine Specialist
1. Reviews previous lab tests.
2. Asks why previous Internist didn't treat thyroid.
3. Suggests that reference ranges are not particularly meaningful, and that one should treat the patient, not the lab result.
Opinion: Thyroid fluctuation could have been my issue long before my TSH started to change. Thyroid is under-diagnosed. Treat aggressively.

Five doctors, four perspectives, two reference ranges, two "wait & see", three "treat", two "aggressively", one "conservatively".

This just shouldn't have been so difficult.

Jan 23, 2010

The past 8 months in brief

When I started this blog, I didn't have a vision for what I wanted to say. Which voice would author this blog?
  • The frustrated patient fighting an invisible illness?
  • The PhD student who studies politics and power in the Canadian health system?
  • Or perhaps the voice of the 'former-health-system-administrator' would come through?
As it happened, none of the things I hoped to say were coming out clearly because my brain had turned into pea soup. I suppose when you name your site "brain fog", it should be a tip off that you aren't in a good head-space.

Last spring I quit writing here, thinking 'if I am sick of listening to myself complain about feeling crappy all of the time, everyone else must be too'.

Summer came and I sank lower into the pit of illness. I won't belabour the point, but I was just seriously unwell.

One day my neighbour saw me on my porch (a big outing at the time) and suggested I visit the "private, executive health clinic" in town. HERESY! Private clinics are for Americans and people who don't believe in the Canadian value of Universal Healthcare. It would be an act of treason.

The fact is, I was too sick to care about my values anymore. I had stayed the course with the public system and I was getting worse by the day. So off I went to the private clinic for a health workup complete with smoked salmon and orange juice.

The private clinic picked up something that everyone else seemed to have missed. Hypothyroid & Anemia. I would never, in a million years imagined that these two benign sounding conditions could cause all of the physical misery and cognitive problems I was having.

But the results don't lie. After two months of treatment, I started to feel better. I started to read books again. I started to walk upstairs without having to rest halfway. I went back to school. I took on a volunteer position in clinical social work. And I haven't looked back (very much).

Interestingly, since my thyroid came under control, I have had almost no symptoms of depression. I am grateful for the chance to feel healthy again and I am angry at the internist who told me my problems were "all in my head". I also am perplexed that it took a private clinic to take my complaints seriously.

What does this say about the Canadian system that I believe in so dearly? I believe that it has something to do with the power that being a 'consumer' of health services confers on a patient.

I felt conflicted between my values and my personal experience - and realized that I may have just tapped into a great thesis topic.

In the end, as much as I would like to find one voice to speak from, I realize that, like all of us, I have occupy multiple roles: patient, practitioner, student, researcher, critic & proud Canadian.

So, I'm thinking of blogging again. I'm not sure where it might take me, but hopefully there will be some interesting discussions along the way!