Wednesday, February 10, 2010

Endocrinologist Appointment

So Monday I met with the new doctor based on the recommendation of my PCP.  He's a specialist in diabetes and thyroid.  My thyroid labs shows everything is normal but just kissing the top of the normal range - everyone seems to feel this is fine so it's not a concern.  I don't have diabetes but my past history with PCOS (polycystic ovarian syndrome) is usually a pre-cursor to diabetic issues because of the insulin resistance.  So seeing this doctor (Dr. T.) was a logical choice.

Just a reminder.... I'm seeing this doc as part of my attempt to figure out why I'm not losing weight. I haven't lose anything in 15+ months and nobody can figure out why because I'm consistently in a calorie deficit and should, in theory, be losing 2 pounds per week.

Dr. T. had obviously reviewed my file before he saw me and was very familiar with WLS in general - so that was encouraging.  One thing he told me that I was a bit surprised about.  Even though all my outward symptoms of PCOS have disappeared with the weight loss, all the hormonal havoc that goes along with PCOS is still going on inside my body.  And the reactive hypoglycemia is probably a direct result of the insulin resistance portion of PCOS in combination with RNY.  So remember back when I discovered that PCOS was the root of my obesity and inability to lose weight?  Yeah... so now I'm feeling that resentment all over again. I had mistakenly thought the PCOS was gone and no longer an issue for me.  Dr. T. confirmed that because of the PCOS (and even with WLS) that I need to work three times as hard as anyone else just to lose the same amount as someone without PCOS.

We talked about my food journaling and my average of 1300-1400 calorie intake.  He was fine with those numbers and said to keep journaling and to keep my intake within that range.  (Good, because that seems to be where my body is comfortable with food.)

We talked about my GoWearFit and that I knew I was burning about 2100 calories on a sedentary day and 2300-2400 on an active day that included exercise (which wasn't often these days).  He wants me to burn an extra 300 calories every single day.  Which for me is about 1 hour brisk walking (or similar to what I'd burn during a 5k race with a time of around 50 minutes).  Ummm.... I could have said "sure, I'll do that" - but I know it's not a real possibility at least 3 of the days of my week.  I'm barely keeping my head above water on school days and I can't see an extra hour hanging around anywhere in my schedule.  So I told him the truth and he accused me of being resistant to his suggestions (I can't remember his exact words, but they weren't nice).  Would he rather I lied to him?  We had discussed my schedule so he knew I was gone from 7am to 11pm most days of the week.  I dunno - kinda pissed about that whole discussion.  To me it smacked of those typical doctor recommendations of "eat less, move more".

We discussed that my GYN has taken me off the Depo Provera as an attempt to help me lose weight. (He didn't think that'd make much difference.)  So no Depo means I'm not taking anything for birth control (not that you need birth control when you're not having sex, of course) -- but he was concerned that I was not taking anything to help control the PCOS and endometriosis. So he's asked me to contact my GYN and ask to be put on a low estrogen birth control pill.  He thinks this will help with the hormonal imbalance from PCOS and also assist with my bone recovery related to the osteopenia.  I'll call Dr. O and see what he thinks.

(I know this is getting long, I'm sorry but it was a big appointment with lots of info.) 

Ok, so here's the BIG one.  Dr. T. asked me to try a diet pill.  OMG right?!  That was a huge shock to me and I seriously balked at his suggestion.  Why would I need to take a diet pill when I have the best tool for controlling obesity right inside my body?  Why can't we just make my RNY work again?  I hate the idea of a prescription diet pill.  Hate it. Hate it. Hate it.  It makes me feel like a failure.  I couldn't lose weight on my own pre-op - I was a failure.  So I had RNY.  I lost for 10 months with RNY but then I couldn't lose any more weight no matter how hard I tried - another failure.  And now I'm told I need a diet pill to make me lose the last 30 pounds.  Sure does feel like another failure.  It makes me cry when I think about it too much.  So yeah, I hate this part a lot.

Even when Dr. T. gave me the Rx slip I still wasn't sure if I was going to do it or not.  You know me, I had to do the research on it.  The drug is called Adipex.   It's designed for short term use to help jump start weight loss. It's a slow-release drug, so not sure how that would work with my shortened digestive system since we are discouraged from using slow-release drugs. The drug is designed to do two things.  It boosts metabolism slightly.  But mostly its an appetite suppressant -- which seems silly for me since I don't really get hungry post-op and controlling my eating is not a problem. So I'm not sure what the appetite suppressant part of the drug will really do for me.  One of the big side effects is jitters and possible high blood pressure.  A lot of people who report on their experience say they had huge amounts of energy because of the stimulant of the drug - but also that they had difficulty sleeping because they were so wired.

After the research and some soul searching, I finally decided to give this a try.  No, I'm not happy about it at all - but after re-reading my post about all the work my medical team was doing -- and my commitment to do whatever it'll take to figure this thing out.  I guess that answered my question, huh?  I gotta try, at least.  I don't have to be happy about it, but I gotta try.  I took my first dose this morning.

So in addition to the Adipex I'm also going to redouble my efforts in food journaling -- being more faithful with recording stuff every day instead of just a few times a week -- and also with figuring out how to exercise more.  Even if I can only find time to workout 3 or 4 days a week when my schedule isn't "quite" as packed, I'll do what I can (shoveling snow counts since we got 8" last night!).  School is done in 5 weeks so my time crunch should let up a bit soon (until next semester of course). I'll work on fixing the treadmill today - replacing the motor that's been dead (I've got the replacement part, just need to see if I can install it properly).   I'll get my Gazelle back from my parents and have that as variety to the treadmill.  Just read about the health benefits of skipping rope, I might even dig my old rope out and give it a try.  I'm going to try.  I see Dr. T. again in a month.

So there you go.  It's all been weighing on my mind ...but oddly, it feels a tiny bit better to have it all written out here and out of my head.  Thank you all for your support and encouragement.


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