It's back.

Depression. I'm pretty sure it has come back.

Today's feeling of tiredness isn't the usual, more physical feeling of fatigue that I'm used to. This time it is a sense of deep apathy...like getting up sounds nice, but staying in bed is just easier.

I've been trying to go for a walk now for the past four hours. I haven't even made it to my shoes yet. The heaviness feels unbearable.

We've had some stressful issues to deal with lately, and when I think about them, my eyes tear up and I feel overwhelmed.

Where did this come from?! I was doing SO well. I was back on the treadmill, even running for up to 15 minutes. This time last week I was thinking I might be able to get back to school again soon. 

Is it even remotely possible that the T3 has triggered this? I know it seems unlikely, but that's the only change I've made recently.

Now I just want to lie down in a dark room and close my eyes. 

I hate, hate, hate depression.

Adding T3

Despite my reservations, my visit to the endocrinologist actually went quite well.

The resident who took my history for the better part of an hour was excellent. She quickly picked up on my anxiety and skepticism from previous medical encounters and assured me that she would cover everything possible during my exam. Her presentation of my case to the specialist was impressive - she summarized everything I had shared with her into a complete profile, highlighting the issues that she most felt related to thyroid. Her future patients are going to be fortunate to have such a thorough and caring physician.

The endocrinologist told me that adding T3 made virtually no difference for most people - the only notable exception being people with depression. Because of my history of depression, he thought it would be worthwhile to try adding T3 at 25mcg/day (half in the morning, half at night).

The theory is that in some people, T4 does not effectively convert to T3. I pray that I am one of these people. What a joy it would be to feel like my 'old self' again.

One interesting aside - both the endocrinologist and the resident noted my high ANA level (1:640, speckled), saying that it was suggestive of 'some other process' going on in my body. They took blood tests to look for markers of inflammation; which I should hear more about soon.

So this morning I took my first dosage of T3...and I screwed it up! I took a whole pill in the morning instead of half. Here's hoping all goes well today.

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 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!