went to the internist
 

So I went to the internist on Wednesday. I did not get to see the internist, but the nurse practitioner. She reviewed my previous wacky bloodworks and wrote orders for more bloodwork which I will do next Tuesday morning. She wants an ultrasound of my thyroid done and their office has started the process of getting that approved with my insurance. She was really patient and seemed to be interested and listening when I talked, big positive change from the endocrinologist.

There is a spot in my upper abs that has been hurting mildly. It is more tenderness than pain. I am so used to it that I didn't even think to mention it. After talking I sat on the table for her to listen to my heart, look in my ears, throat, yada yada yada. Then she had me lie down. She started pressing all around my stomach and when she hit that spot I said OW! She said do you know you have a hernia here? I said no. She says the internist will have to take a look at it. I go back on the 17th. The internist will feel the hernia and go over my bloodwork results.

I am aware of a hernia that I have near my bladder which my OB/GYN said at my last visit that I can put off for now but eventually will have to be corrected with mesh screen or part of a cadaver pig. I got weak just from her talking about it. The smells and thought of a hospital make me feel like I'm going to die just when I think about it. And the thought of having metal or pig parts in me does not sound lovely to me either. I just hope this hernia can be left alone or put off, too. I cannot handle this right now.

The nurse practitioner told me that my symptoms sounded to her like thyroid issue or adrenal fatigue. I have never heard of adrenal fatigue in my life but will google it when I have more time. Netflix is calling. I need to veg I am feeling overwhelmed. I will indulge in buttered popcorn and Star Trek:Enterprsie and xanax. :Heart: I am trying to be light-hearted but I am really upset, that's why I haven't posted about it sooner. If you have had hernia surgery please let me know what it was like pain-wise and the recovery time. Thank you!

Please note: the internist has not even seen it yet, no one has told me I need surgery for the one in my abdomen. My mind has a tendency towards worst case scenarios. This is just who I am.

I am glad that you found someone to listen to you. sounded thorough.
sorry about your hernia, that must have been a surprise.
I worry about stuff too...can't help it. my pdoc ordered more klonipin if I needed it.
I don't know anything about hernias.....
don't start googling them!
enjoy your netflicks
bizi

Dear Butterfly,

I apologize for reading this quickly as I am in the middle of a project for work. The nurse practitioner is using made up or (over simplified) language because the Mayo Clinic says that adrenal fatigue is not a medically accepted diagnosis.

On the other hand, actual Adrenal Insufficiency can be diagnosed by blood and other tests to show inadequate levels of adrenal hormones.
See link: http://www.mayoclinic.com/health/adr...atigue/AN01583

I believe that you can request what materials you want for those materials. If necessary, you can get a referral for another doctor who can use materials appropriate for you. I do remember that pigs have material that is very compatible with our parts. Years ago, diabetics relied on insulin that came from pigs.

Try to take one thing at a time:
1 go for the blood work on Tuesday
2 go for the thyroid untra sound

Try not to get ahead too far. You can handle these things one at a time.

M

Dear Butterfly,

Great that you had a positive experience at the doctor's office. She seemed thorough. Did you feel like she was asking the right questions and listening to you? You can write down additional questions you have for the appt with the internist.

It is great that you have an internist. Sometimes they are good at considering the patient as a whole person (instead of a collection of parts.)

I believe that you can do one or two things at a time very well. Focus on how great it will be to know that the issue with your thyroid is straightened out. (Think of the of the other stuff when the time comes.)


M

thank you bizi ! I did enjoy my popcorn & Netflix last night. It was a nice break from reality. Don't worry, I will not be googling hernias, I don't want to know. :Heart:

Thank you for the link Mari. The symptoms that I see that I have for adrenal insufficiency are fatigue, body aches, low blood pressure, and lightheadedness. In fact I was telling her about how I see these silver flecks sometimes if I get up too fast from beding over or sitting up or laying down.

Just pulled out my paper - these are my bloodwork orders:
blood type
CBC, WBC
comprehensive metabolic panel
cortisol, free
vitamin B-12
Epstein-barr virus early antigen antibody
ferritin (which I think is iron, b/c I have been anemic in the past)
free T4
free T3
lipid panel
Lyme western blot test
magnesium level
Molecular isolation or extraction, each nucleic acid type(i.e. DNA or RNA) MTHFR
reverse triiodothyronine
thyroid peroxidase (TPO) antibodies
TSH
urinanalysis
vitamin D, 25-Hydroxy

I don't know what half this stuff is but I do remember her saying something about the cortisol having to do with the adrenal glands, and I see that in the bloodwork she ordered. :Heart:

Yes, Mari, I felt like she was listening. My endocrinologist seemed to dismiss all of my fatigue symptoms and body aches to depression, just because I have a bipolar diagnosis. That was really frustrating!!!! I told this to the nurse practitioner and that I know my body and that there is something physical going on, I don't know what, that's why I'm here. This nurse practitioner actually told me that one of her good friends has bipolar disorder and is fully capable of distinguishing physical pain & fatigue from depression and I just thought to myself thank God!

Seems like she ordered everything but the kitchen sink. But she said we have to start ruling stuff out. My only worry is how much this will cost me. But I want to know whats going on.

I will be very relieved once the thyroid ultrasound is done. Every thing that gets ruled out is a good thing.

She said she wished she could give me a B-12 shot but said that she couldn't until after I draw my bloodwork. She said the internist may decide to give me one when I go back on the 17th. Although I'm not sure how they determine if you need one, I don't see anything on the bloodwork orders checking for Vitamin B but I could be missing it. Maybe their criteria is that you're tired all the time. I have heard that B-12 can give you energy.

Yes Mari, one thing at a time. one thing at a time. one thing at a time. You are right, one thing at a time is manageable. Or should I say more manageable :-) Thank you for the encouragement. :Heart:

Butterfly,

It seems that she is responding to the symptoms you describe. For example, the Lyme disease and the Epstein Barr and B12 could relate to tiredness. I am not up to date on Magnesium.
Short explanation of the blood order:


CBC, WBC -- this is standard
comprehensive metabolic panel -- this is standard as well
cortisol, free --- this will check your cortisol / adrenal glands
vitamin B-12 --- doctors might be checking more than they used to. . . . not sure. . . it might be standard
Epstein-barr virus early antigen antibody --- lots of people have the Epstein-barr marker in their body so it is not a good test but maybe the nurse practitioner is looking to see why you have low energy
ferritin (which I think is iron, b/c I have been anemic in the past) --- Iron as you say
free T4 -- Thyroid
free T3 -- Thyroid
lipid panel -- Cholesterol
Lyme western blot test -- Lyme disease ( you can ask why she is checking for this.)
magnesium level -- Magnesium ( you can ask why she is checking for this.)
Molecular isolation or extraction, each nucleic acid type(i.e. DNA or RNA) MTHFR -- according to this link this has to do with B12
http://labtestsonline.org/understand...mthfr/tab/test
reverse triiodothyronine -- Thyroid
thyroid peroxidase (TPO) antibodies --- Thyroid
TSH -- Thyroid
urinanalysis
vitamin D, 25-Hydroxy --- It is good that she is checking Vitamin D.


M

Hi,

You won the Nurse Practitioner lottery! :trampoline:
I am sooooo happy! :)

She has two tests for B12. She cannot give you the shot until she knows how much you need. The good news is that it washes out of our bodies quickly like Vit C does so it is ok to take a lot. The bad news is that you usually have to keep it up.
Lack of B12 can have neurological ramifications so this is good that she is checking.

Mari

Thank you so much Mari! :hug:

I am such a knucklehead. I typed it out myself, it says right there Vitamin B-12, but I still overlooked it. sheesh. Anyway, she asked if we go camping which we do. That is the only reason I can think of that she is checking for Lyme disease. She asked if I had every gotten bitten while camping. ha! Are you kidding me? Mosquitos mostly though I think.

I don't know why she's checking magnesium levels. I didn't see the orders until the receptionist printed them out when I checked out. The nurse practitioner had typed them into a computer while we were talking. I kind of wish she would have showed them to me before I walked out so that I could ask line by line, what's this, what's that. But you've done that for me. Thank you Mari!

Wow, I'm impressed with the list of test she is doing.

You really did hit the jackpot of Nurse Practioners.

Donna:grouphug::hug::grouphug:

Hi,

I am geeky enough to be bugged about not knowing why she is checking for magnesium.

I just found that low magnesium can be a symptom of Addison's Disease ( When the adrenal glands are not producing enough hormones.) . . . So she was looking to find out why you have low energy.

http://www.nlm.nih.gov/medlineplus/e...cle/000378.htm


Some of us here take magnesium -- At the moment, I can't remember why exactly -- today was a difficult day for my brain.

Mari

It was a very comprehensive list of questions she asked me and when she asked me if anyone else in my family had bipolar disorder I said my dad, his mother, and 2 of my 1st cousins on my dad's side. She asked what year was your Dad diagnosed. I said ummm let's see he shot himself when he was in his late 30's and it was after that. She said OMG I'm so sorry I asked I said oh no, it's okay he lived, I can talk about it. She asked at what age my grandmother was diagnosed but I have no idea.

She said that my thyroid could fluctuate that much in 3 days (recapping here my TSH was 4.96 then 1.86 3 days later) if enough cortisol was in my system. That is when she started talking about adrenal fatigue. She started explaining how cortisol is a flight or fight response and that it can get turned on and stay on sometimes. She asked if I had been under any unusual stress lately. I explained about my friend's suicide in February and it was after that that she told me that she had a good friend who has bipolar disorder. She said that her friend "has to stick to a schedule and that she can't take on too much but otherwise lives a normal life". And also that her friend would know if something new & physical started with her.

So I am glad that I confided in her what I did about my dad and my friend because I believe that's why she confided in me about her friend. And I trust her more now. Because she knows that we with bipolar are not some dumb, un-selfaware alien species like my endocrinologist made me fee. We're just regular people like her friend.

Also, I want to tell this to you guys. She asked me if I ever read medical literature. I said no, I can barely read an entire magazine. ha! Anyway, she said that there is a school of thought in some medical journal she's read that people with bipolar disorder are rapid metabolizers. I can't remember if it was all vitamins or just the B vitamins. Ya'll ever heard of this? :Heart:

You are right Donna!

I told all this same info of my symptoms to my endocrinologist and all he did was order a thyroid panel. :shaking my head: :Heart:

AWESOME info!!!

I'm so grateful she's at least interested enough in my case to check into it! Thanks Mari! :hug: :Heart:

Oh I forgot to say that magnesium is in a powdery stuff I take some nights called CALM. It has magnesium and is supposed to help you sleep but I can't take it every night or I get loose bowels (sorry if that's TMI) :Heart: And I think it is supposed to help with restless leg syndrome. I don't have RLS, just going by what someone else told me.

Yeah, was getting the same results from the CALM. Then I found out on the board that I was taking it wrong. You have to use warm water like the instructions say. The warm water changes it to a form of Magnesium that is absorbable. The kind used with cold water mostly goes through the body -- waste of money unless you are taking it for that reason.

M

oh no Mari, warm? say it ain't so! eeewww! :stomping my feet like a 2 year old: I don't know if I could drink it warm. Thanks for letting me know what I've been doing wrong! :Heart:

Butterfly,

I used to do it warm and then let it sit until it was room temperature.

Or you could use a little warm water so that it is properly dissolved and only a little later use cool water.

Mari

Hi Butterfly... real glad you found such a great NP! :)

The B12 tests need to be done before giving supplementation, because giving you the shot first could mask a deficiency. they need to know if you are deficient or not, because if you are they need to figure out why. depending on why, treatment may be temporary or permanent, and how supplementation is given may vary as well (eg sublingual & IV vs. tablets). I am a little surprised she isn't checking folate along with B12, they often go together. Also, homocysteine levels... the test she ordered is usually a followup which can explain high homocysteine levels but if negative will not tell whether levels are high or not. However the B12 check is really important.

Magnesium would be fatigue and stress related. Low magnesium can explain fatigue, muscle aches, tension and cramping.

~ waves ~

CALM requires *HOT* water!
 

To all using CALM:

CALM must be dissolved in HOT water. As "hot" and "warm" are both subjective terms, what is "warm" to some may not be hot enough for this process. The instructions do say hot, not warm and specify a minimum amount of water to use per dose:

http://www.calmnatural.com/natural-c...nesium-citrate
NOTE (unspecified on the label): the stuff is ready to drink after fizzing has stopped. at that point whatever you do to it - add hot, cold, or iced water, the magnesium citrate is stable.

two things happen here:
1. physical dissolution of anhydrous citric acid(one component of the powder) in water and
2. chemical reacion of the calcium carbonate with HOT citric acid, yielding calcium citrate in aqueous citric acid solution. this reaction produces "fizzing" because it releases carbon dioxide. so, fizzing tells you the reaction is not complete - that's why you need to wait till it stops before you drink up or do anything else to the preparation.

So then.... how hot does "hot" need to be?

At one point I'd found a chart that told me optimum solubility temps for bunches of salts in different solvents. Alas, I cannot find it again! :rolleyes: What I do personally is heat water as though i were making instant coffee... i bring it to steam point but not to a full boil (as i would for tea). Then I add the stuff and then i let it cool down. that's probably hotter than needed but i am sure, that way, that as it cools it will certainly pass "through" critical solution temperature.

hope that's helpful and not too chem-geeky. ;)

~ waves ~ a once-wannabe chem major

:hug:I take magnesium tablets for my fibromyaligia. And other aches at times.

It is something I have to find the tablets or I can't swallow them. So
when I start to run out I'm always out looking for them.

But they also help with fatigue too.

Donna:hug::grouphug:

Donna - magnesium citrate drink
 

Donna

have you ever tried the Natural Calm product? This is taken as a drink, hot warm or cold. tastes a bit lemony but you can dilute it as much as you need.

Also here, i get magnesium pidolate in tiny vials. Here that is branded as Mag2. it is a clear liquid. No shake, no bake and no stir. Just uncap and drink (it's maybe a tablespoon and 1/2 worth no more). it is the most rapidly absorbed form. my neuro gave it to me for migraines (to help prevent/reduce the hormonal ones).

i guess, i am not clear what form it is you cannot swallow - if it's certain pills, or if it's the liquids you have trouble with (i'd think liquids are easier?)

~ waves ~

Very helpful info!

I am officially a knucklehead. I always used cold water right from the fridge spicket. And also, I drank it while it was still fizzing. I thought it was supposed to be like that. I thought it was like Alka-Seltzer.

Thank you waves - I apparently did not read the instructions. :confused:I've already gone through 3 or 4 containers of this stuff in the orange flavor. :Heart:

Dear Butterfly,

You were still getting some magnesium --- just not the kind that the body can fully absorb. Even then, some was still getting absorbed.

Some people take CALM to help with sleep, leg cramps, and so on.

If you need magnesium, you can get it in food sources: almonds, dried apricots, dates, . . .
I like sliced almonds on my salads.

Also try these links:
http://theconsciouslife.com/foods-high-in-magnesium.htm

http://ods.od.nih.gov/factsheets/Mag...hProfessional/

(The full 2 rounded teaspoons on the instructions of the CALM prepared according to instructions are 350 mgs of magnesium but some people get loose stools at that dose and need to experiment to find the right dose.)

It might be good to not make any changes to your diet until after the blood work for the Nurse Practitioner.

M