When it's in your body, not in your head...

I'm used to being sick. I started getting sick in my 30's. First, it was what the doctors called "depression" because they couldn't find a reason for my swollen ankles, constipation, lack of sex drive, irregular periods, hair loss, and weight gain.

I can justify their neglect by saying that part of the reason tests never revealed a thyroid condition was due to the fact that I was taking birth control pills. Since my problems in the early '90's, experts have discovered that the pill can mask various thyroid problems.

But I am more inclined to say that their lack of concern, and their insistence that whas was happening in my body was all in my head reflected a prejudice against women: that a perfectly healthy-looking early 30's woman with low blood pressure and all those other symptoms, whose blood work shows appropriate numbers, is more than likely suffereing from something in her head than her body.

I never thought to question the doctor's ability to read test results correctly. I also didn't have the option of going to another doctor. This all transpired during the early days of HMOs. At that time, insurance companies that offered HMO coverage could only offer the coverage thru various clinics....where there was no guarantee that a patient would see the same doctor twice, since most of the doctors were in the last stages of their residencies at local hosptials and would leave within a year or two.

The idea of a "primary care physician," of one single person that the prospective patient built a relationship with was pretty much anathema to the ideal of cost-effective medical care for the masses. HMOs as a bizaare form of socialized medicine that we all paid for out of our own pockets. It was an imperfect system, to say the least.

It took roughly 5 years from the time I first begain to feel ill to when, finally, a doctor that I'd built something of a relationship with finally found something in my body, not my head. HMOs had changed, but once one has the word "depression" pinned to her chest, it becomes the main criteria for diagnosis. Over the five years I took prozac, paxil, serizone (now off the market)and zoloft. When my period stopped for 4 months, and my blood pressure dropped to some unbelievelbly low two digit number did the doctor believe the problem to be in my thyroid.

My condition didn't start to stabilize until I ditched the anti-depressants, soy products, and albuterol. After that, my depression lifted, my weight-gain stopped, and my energy levels improved. All I took was my thyroid meds and a few boostser vitamins.

So, 4 months ago, around the time of my mother's illness and death, when my ankles started swelling, and I started to gain some weight, and my thinking seemed kind of cloudy, I didn't really consider the problem to be in my body. I'd noticed some odd things like skipped peirods, some hair loss, and problmes synthesizing my vitamins before the last time I had my meds checked in March, but the doctor brushed those off as little anomalies, nothing to worry about, I had the b.p. of a teen-ager, and so forth.

I was, though, slowly getting sicker.

That's the thing with hypothyroidism--the decrease in proper hormone level can be very slow and subtle. The change can be so subtle that the tests they use to determine TSH do not pick it up. The change can also be in one kind of TSH and not another. A change in T3 may not affect T4, but if one of the T's isn't at the proper level, one can get very, very sick. Often doctors will only test for T4 because they are seeking to keep test costs down. And if the patient has been stable for several years, there isn't much of a need to test T3. Keep down the cost, rubber stamp the perscription and send them on their way.

By last friday, I'd hit critical mass. Every time I ate a meal that cosisted of more than eggs or cereal, I got the runs. To the point of needing Pepto Bismol to control it. I was bloated and according to the scale had put on 10 lbs. My ankels looked like they were inner-tubes. I was having pains in my calves. My heart would race and I would have to lie down alot. If I wasn't in an air-conditioned deep-freeze I would be so sick that I couldn't eat nor keep my eyes open. I was having anxiety attacks like crazy and was obsessing over things I could not control nor remedy in 5 seconds. My appetite was gone and looking at food made me ill.

I knew my thyroid was off, but I also felt that if I went in with this list of symptoms, the doctors, who don't know of my checkered history with anti-depressants, would hear the words "anxiety attack" over the phrases "swollen ankles" and "weight gain" and I'd be place on some anxiety control meds. Especially after I told them my mom recently died and that I was in the middle of an uncertain career change. Oh, that would be a total reason to medicate me into a mental stupor and not treat my physical body.

Strangely, this time I got thru to a sympathethic nurse, who actually heard me when I said that I was having problems with the heat, with my digestion, with my legs and ankles. Maybe because I used the term "heat related edema" and skipped any mention of the anxiety attacks. And when I saw the nurse practitioner on Monday, the first thing she asked was to see my legs, to which she said "oh my!" and quickly wrote me a scrip for a higher dosage of synthroid.

I've been walking around like this since April. I have been sick thru my mother's funeral (now I understand the headaches) thru the summer, thru my trip to Blogher. I don't trust doctors as much as some people because, even now, my concerns about weight gain and my low b.p. (I am best at 120/30, not 110/20. that's a teen-ager's b.p., not a 40 year old's) are still tossed aside as attitude adjustment problems, and all I need is a little encouragement that the b.p. is normal and the weight gain is just age and too much Ben and Jerry's (which I rarely eat). I've learned to tolerate pain, to take potassium for swelling, green tea for anxiety, generic brand zantac for stomach trouble, and pepto bismol. I buy pants a bit too big, and wear looser-fitting tops when I'm bloated. I've learned to soldier thru the leg pain and go for short hikes, which help the swelling and the pain for a bit even though I'd have to take a nap afterwards. I could apologize for my bad moods and forgive myself for not being able to socialize properly in crowds. If I missed an opportunity to connect, I learned to be patient for another to come along.

It's been a few days on the new meds. I've lost 6 lbs., am eating better, and my ankles look normal again. No leg pain, but rear-end pain from sitting too long in a lousy desk chair. There are still some stomach/digestion discomforts, but I know it takes a bit of time for everything to balance out. Most importantly, my brains are out of hock and my head is clear.

With a clear head, I'm imagining what I can accomplish. I might even be able to take on L.T.'s suggestion that I pitch an article to the NYTimes.

Imagine that. Somebody suggested I try to pitch the NYTimes. Go figure. Guess the only things that are really in my head are some very, very good ideas. :-)