Decisions, decisions...

I saw my doctor yesterday and told him how feelings of anxiety and depression were creeping up on me again. He raised my antidepressants and ordered a long list of blood work.

Did I mention that I hate 12 hour fasts? I love breakfast. Anyhow, I got 10 vials of blood taken this morning and will likely hear back soon if anything is not normal.

My prediction:

Normal labs for all except ANA

The doctor still continues to think there is something 'else' going on with me that has nothing to do with my depression.

But he did council me that stress isn't good for any condition; physical or mental.

He advised that I visit with the Dean of my program and try to sort out getting a new advisor. He thinks I will feel much better once I deal with this issue.

I told him I'm thinking about quitting the PhD program and he has encouraged me not to make any decisions until my current depression lifts.

I do agree with that advice, but in my current state, going to meet with the Dean feels overwhelming.

Where's my IgM?

Back from holidays - what a glorious trip! I snorkelled with stingrays and spent as much time as possible outside in the shade enjoying the pool. What a difference a little health makes!

I returned home to some interesting blood lab results. My ANA is still 1:640, but my ENA is negative, ESR is negative and anti-dsDNA is negative. That's a whole lot of negativity!

But there was also something else missing...apparently my Immunoglobin M (IgM) is on the 'low side'. I'm not as up to date on immunology as I would like to be, but I think that means that something is up.

Oddly, my CK was elevated, which is weird because I hadn't been exercising before my test or doing anything else that should have affected the results.

Also, my MCH is high (which has been consistent for the past few years). My B12 and Folic Acid are ideal and I consume next-to-no alcohol, so that doesn't make a whole lot of sense either.

I really need to go to med school - if only to make sense of my own lab work!

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.

the headache

I saw the Internist today. What a letdown. No answers yet.

Of course, I knew that she wouldn't be able to tell what is wrong with me with one visit, but I was so hopeful that there would be an answer in sight.

She is doing more blood work and told me my thyroid is enlarged and my cortisol levels are low (adrenal fatigue, anyone?)...I will get my blood taken tomorrow, but won't get the results for about three weeks.

My headache is back. I feel nauseous and will be putting my laptop away soon as the light is making it worse.

I'm not sure how much longer I can handle this relentless headache. I am in tears tonight trying to manage it.

Tylenol 3 + Advil = no relief

Any other suggestions? I'm at about 8.25/10 on the worst headache of my life scale.

my titers (or lupus part II)

I just got my lab results in hard copy. I thought I would post them to see if any of you can make more sense of them than I can:

ANA: Positive

TITRE: 1:160

PATTERN: Homogeneous pattern

Speckled pattern