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No tracking this week. Or next. Holiday time, and hosting time, and a few random stresses on top of that, and my weight's all over the place. It'll settle down once normal habits resume.

I do note that my blood pressure's definitely responding to medication. Down 40-odd points on the high end, 8-10 on the low end, and the pulse is coming down a bit too. Happy. :)
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This was the second of two no-weight-tracking weeks, as I've been seeing how my body takes to amlodipine. The answer: really, really badly for a couple weeks, but I'm experiencing enough relief yesterday and today that it does make sense to do what my doctor suggested today - stick with it another week or two, unless bad reactions come back. 

Speaking of doctor...

This summer my A1C, the measure of long-term overall blood glucose level, was at 8.3%. The range for healthy adults is 3-6%. As of the test two weeks ago, it's 5.5%. There'd been a delay in getting the results delivered to Dave so he was actually looking through the report while I was there. He turned the page, read that line, put the report down, turned to me, and nearly shouted, "Dude!" (For which he apologized later, but I giggled. I'm willing to forgive an exuberantly happy doctor.)

He'd been hoping for about half a percentage point improvement. Apparently each half-percent reduction in A1C reduces the risk of kidney and liver failure and of damage requiring amputation of fingers or toes by about 20%. I asked him if a three-percent reduction meant I should expect to be growing anything. He didn't think so. :) But he says it's the best result any patient of his has ever achieved in the initial six months.

So I'm a happy camper today. Measuring weight resumes.

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I'm not actually tracking my weight this week. With new medication and other hoorah, it didn't feel like there was much point. I plan to skip this report and the one for next week, and have actual data again for week 29.

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This morning's appointment went very well. I'm happy with my progress. Dave is really happy with my progress. We reviewed my diet, blood glucose readings, exercise history, some personal developments, and like that, and he sees much to be happy with. He thinks I'm being a good patient, which makes me happy, as I'm trying to be.

My blood pressure sucks. A lot. It was 200/112 in his office at 9 am. This is not good. I am therefore going to try some blood pressure medication for a couple weeks, and go in for a quick reappraisal the week after Thanksgiving. He is confident that we'll find the thing that helps, though.
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It turns out that the reason this particular bunch of shaving gel absolutely failed to foam up well is that it was shampoo.

I'm off for a checkup this morning. Time to update the blood chemistry tests, and I'm really looking forward to finding out what's up.
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I have new shoes.

Now, to a lot of people this wouldn't be a big deal. But those of you who know just how sick I've been in recent years may get a sense, and I'll see if I explain it to the rest of you.

I spent five years really pretty much housebound, you see. And early in that time I developed very severe edema in my left foot, ankle, and shin. I had to wear sandals, unless I were going to try hunting out men's size 15 or 16 or so, instead of my regular 12-13. (I'm not sure any available size would actually have done the job, but it would have to have been at least that much.) It was depressing. I couldn't go anywhere much and couldn't wear anything appropriate if I could, and it was just a very bad loop.

This year, of course, I've been improving a lot, and with winter starting to close in, it became clear that I both should and could have some real shoes again. So last night I went out, hunted unsuccessfully for a while, and then got first-rate service at a nearby Macy's. (I've realized that I take it as a good sign whenever I run into someone who's paid by commission and willing to talk slowly. It seems to go with quality attention.) Now I have a nice pair of well-fitted black casual oxfords, which will do me just fine.

I am really, really happy about this. 
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I'm just in from 44 minutes' continuous walking - nearly 5000 steps, more than 2 miles, and with major uphill and downhill action.

I love this time of year, when rainy mornings give way to dry, even slightly sultry, evenings. Making the most of them for exercise, yes I am.
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Says my pedometer:

16,9340 steps
10,1510 aerobic steps (in stretches of 15 minutes or more continuous walking), 91 minutes aerobic walking time
998 calories burned, not counting in elevation
6.41 miles total

And on my evening walk, I walked up to the top of Phinney Ridge and past the entrance to the zoo for the first time in five years.

I am getting better, by golly.
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This has been the way of it: I keep a daily log of what I eat in Weight Watchers' online log so that I know the points value of what I'm eating, and do a loose daily tally in my head to get a sense of how many carbohydrates I've eaten so far, and leave the detailed math on carbs to writing up notes on training day. That's today, so I'm going through my August food log to do the math.

I've been off on my carb counts. Way, way, way off.

How off? I'll tell you. The goal for someone in my condition is about 180g of carbs per day. What did I eat the first seven days of this month? 112g, 176g, 94g, 120g, 158g, 103g, 154g. Which is to say that on average I was about 50g short, and that adds up to some good generous servings of things I've been avoiding, including fruit and rice.

I'm deeply embarrassed by the magnitude of my error, but glad to know about it, and very glad indeed that it's a matter of having fallen short rather than overeating that much. And I think I'm going to do the math daily for a while.

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Seattle's having a heat wave. It's not the worst heat in the world, of course, but it's like the other extreme of persistent ice—something the city's infrastructure just isn't designed for. There are a lot of offices not ventilated and cooled well enough for it. And one of them is the room where we're having our diabetes training. The projections for Monday's high have been going up and up and are crowding the hundred-degree F mark, and my class is 1-4:30 pm. It was uncomfortable there this week with a high in the mid-80s. I realized that I've been feeling real dread about it, because high heat messes with my internal problems a half-dozen different ways. (If you've seen what high heat can do to someone with epilepsy or cerebral palsy, it's similar: bad reactions happen more often and are worse and harder to recover from.)

 Realizing that I might have a real legitimate concern, I did what I often do in such things: start by talking to Mom. She knows my situation and tends to give me good advice. She suggested I write to Dave, my gloriously wonderful nurse-practitioner, and see what he suggested. So I did.

Within 20 minutes, I had a reply back from him. He agreed that it was a concern, gave me some recommended phrasing ("heat intolerance", in particular) and a phrasing to take to the diabetes people, and said he'd do the same. That at 9 pm, a time well past when I'd expect any sensible medical professional with daytime office hours to feel an obligation to check e-mail, let alone to respond to anything so non-critical.


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I didn't mention it earlier, but I've been drinking a lot of Pedialite and Powerade Zero the last few days, and it seems to be paying off. My stomach is a little better or at least has stopped being noticeably worse, and my mood's a lot better today. I also got some great day-job freelance work lined up, of a sort I can do really well even while somewhat impaired, and the boost from being productive in a fun way will reinforce healing tendencies, I'm thinking.

Now to keep cool through a few warm days.
ceri: Oncoming plane and stylized VROOM (Vroom)
Okay, yesterday's readers know that I was  very down about my weight, and approached the scale this morning with great trepidation...

Down 2.6 pounds! Holy cats, as a cartoon character would say. And this in a week when I ate out five times, including once at blush McDonald's. Of course I walked a lot, too, and that really for true does add up, plus taking the hypertension medication. Plus maybe my subconscious being ornery about the fat thing. But whatever the reasons, I am glad. :)

(That's a total of 9.4 pounds in 7 weeks, which is a fine cumulative result so far. Weight Watchers regards 1-2 pounds a week as healthy and sustainable. I imagine that I'll be back to losing fractional pounds, but this was, I guess, something like clearing an obstruction in a waterway.)

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I've always had this small bit of luck: I've never been told "We can't do the thing that would help most because you're too fat." This has always been a slight surprise to me, given how heavy I am, but welcome. Well, that run came to an end today. I am too fat for the kind of compression hose the vascular specialist would prefer that I use, so I'll be making do with something partial (once we find out what Medicaid will cover) and monitoring to make sure it's doing something for the rest of my legs.

I'm discouraged.

I don't need efforts at cheer or reassurance or any of that stuff. I'll be keeping at it, doing what there is to do, seeking the relief that can be had. Things will change. I just need some time right now to go ahead and deal with one of those hurts I've been dreading for a very long time that finally arrived.
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I'm very low today. I'l explain why after I'm out of the slump. It's not "oh, yeah, you're gonna die" news or anything like that, just a huge nuisance because of circumstances I hate and can't fix.

I don't need anyone's efforts to cheer me up. I just need some time to get my footing back. Posting later.
ceri: Femme fatale (Brigid O'Shaunnessy in Howard Chaykin's Blackhawk) (Brigid)
I forgot to mention. The other thing about my nurse practitioner is that he's a fellow Firesign Theater fan.

He was preparing to give me the hepatitis vaccinations and started yawning a lot. He explained that he's developed an allergy to sulfa. I said, "Oh, I thought it was just such a long exposition." He stopped dead in his tracks, turned around, and said, "Now that's just classic", and we spent some time agreeing on the merits of Firesign Theater.

Those of you not familiar with these guys may listen to some of their best material in this three-part playlist. Firesign Theater's specialty is audio humor of a thoroughly anarchic sort; they are to American culture more or less what Monty Python was to British.  
ceri: Femme fatale (Brigid O'Shaunnessy in Howard Chaykin's Blackhawk) (Brigid)
Another day, another appointment.

My nurse practitioner is very, very happy with me, and I'm very, very happy about that. Apparently my level of dread isn't unusual, and my practice in needing to go ahead and do stuff while feeling dread is paying off in more rapid establishing steps than he was expecting. Mutual satisfaction ensues.

My thyroid levels are actually right in the middle of the healthy range. That's a surprise, too, and welcome, since I have a history of low thyroid and one of my siblings had thyroid cancer a few years ago. Not everything that could be broken in my body actually is! :)

I've got a prescription for anti-diabetic drug metformin, which I'll start after the 4th of July holiday.

I have to check with the state about what forms of testosterone delivery they'll pay for, with the nurse practitioner telling me to expect that it'll be injection, since it's much cheaper the alternatives (and, he tells me, most effective in the long run, in their experience). I was feeling tensed and unhappy about this prospect, and I'm much relieved now. He reviewed the crucial concerns with me. First, infertility. Well, I'd decided long ago that I didn't want to subject a child to the genetic lottery I carry, and I've never been well enough to be anything like a good parent anyway. Second, testicular withering and contraction. Doesn't happen to everyone who takes a lot of testosterone, but it's common, and irreversible. He paused after telling me this and said, "This may not be as big a deal to you as to many of our clients." Right he is about that.

We went on to talk some about general long-term prospects, and the upshot is that he sees a lot of reason to be confident. And he thinks that what we're doing now will open up options for whatever I later decide to try when it comes to hormones - with a lot of weight off and my body in generally better shape, and the depression substantially lifted, I will be able to taper off the testosterone and be set for further treatments. 

So that's all really, really welcome.

Next week: Vascular specialist on Monday, trying out the Ingersoll Center's group session on Wednesday, first of three diabetic training sessions on Friday. Yeesh. I'm getting a lot of chances to eat out. :)

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Held steady this week at 323.6 pounds. Given the week, I regard that as a rousing success. :) And the trend is in the right direction. Hoping for reduction to resume in the coming week, but honestly, in the midst of the current medical crisis, I really do think that not ballooning up from stress is a really good sign. So no worries here.
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On Monday, I set myself the following goals:
# Call the doctor's office to schedule an initial appointment.
# Ditto with the dentist.
# Do 30 hours of research for Project N.
# Do 5 hours of actual writing for Project N.
# Get my old clothes definitively sorted, with a tally of what's to be donated, and get at least half of that to Goodwill.
# Do 5 hours' free writing on hopeful concepts, as per recent musings about good-news writing.
# Get players in my Soul Leverage pbem/pbp game the info they need to make characters.
# Take 5 photos I want to share.
# Get out for one purely fun outing.
# Make both of the new-to-me crock pot recipes I've got the ingredients for.
Let's see.

# Called doctor's office and got an appointment for the very next day. And the results of that tossed everything into or at least in the direction of a cocked hot.
# Did get clothes sorted and three Hefty bags' worth of useful but not-fitting-me-now clothes, bedding, and towels ready to take to Goodwill.
# Did take and post 5 pictures I like, from my Wednesday outing.
# Fixed one crock pot recipe and enjoyed it a lot, but haven't gotten to the other yet.
# Did not call the dentist. I'm going to get the current crisis sorted first, and call the dentist in a week or two.
# Only managed 11 hours of research, and no free writing or gaming set up.
# Didn't get out for fun, alas.

But given that the Wednesday visit did include news of unsuspected life-threatening problems, I think I did very well, when grading on a curve. :) I'll aim for some updated goals for the coming week.

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(This is a reworked version of what I posted to my original LiveJournal. A few of you will be seeing it twice.)

I'm back home from my initial appointment at Capitol Hill Medical. Wow did that go well. I liked the place and the practice—much higher standard of courtesy among patients and staff than I've become accustomed to, for starters, and the guy who examined me was just fantastic. And he knows two friends with porphyria, which let me save a lot of explaining.

The punch line is that I am as sick as I think, but not in quite all the ways I'd guessed. First off, my blood pressure has gone ghastly high. High enough that he said it was genuinely surprising to him that I haven't had a stroke. I've got a prescription for medication to start tomorrow. He also feels very sure I've developed diabetes, though he won't know for sure until the blood work comes back; I find out about that tomorrow. Beyond that, he said that they've found a strong correlation between too-low testosterone levels and some of my major symptoms of recent years, including the worse-than-usual weight gain and mood loss. Again, test results pending (and I've got a follow-up visit for a week from Friday).

The hormone stuff in particular is going to be a pain. He was upfront about it, saying, "We have a problem here." They are quite willing to work with me on the medical aspects of transition, but he explained that getting my testosterone up for the duration of getting out of this particular crisis (he thinks my 2004 collapse was an environmentally triggered failure in T production) isn't incompatible with reducing it again later once I'm no longer critically obese and depressed and deficient in energy. I buy that. It just means delay at a time when delay is not really what I want to hear...but I am not surprised, to tell the truth.

It also turns out that what I thought would be a case of dermitits is in fact almost certainly venous stasis and some associated edema, so I also need to check out vascular consultants and expect to spend time with some sort of compression system.

I am, um, overwhelmed, a bit. I mean, I knew I have problems. But there's something about seeing them so directly laid out and approached as matters both needing treatment and susceptible to it. It will indeed be the years of work I had guessed to get things under control. Please pardon me if I have some whiny moments along the way.
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A minor disappointment here: up a pound this week. But I got in good exercise (particularly the day I went to my counseling intake interview) and I'm eating right; I have a touch of a summer cold, and allergies from major work the landlady's doing in the backyard. I'm confident it will come back down.


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Ceri B.

April 2010

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