New Doctor, New Direction

Last week, I promised a blog post dedicated to the issues that have sidetracked my journey to better health, so here goes! It won’t be a short post, but it should be pretty thorough.

After the new year, I was really struggling with my weight, my health, and my emotional well-being.  I knew that everything was related to one thing — my severe insulin resistance — but I couldn’t seem to get on track with my eating long enough to get back into nutritional ketosis.  I felt frustrated, defeated, and worthless.

Desperate to make a positive change, I began the search for a doctor who could help me.  I had some criteria.

  1. The new doctor absolutely had to support a low-carb, ketogenic meal plan.  In my mind, this requirement was non-negotiable.
  2. I wanted to find someone who was highly recommended in the low-carb community.  That way, not only would my eating plan be supported, but the doc would also likely share many of the other views that are dominant in the low-carb and Paleo communities.
  3. I really wanted to find someone who was more skilled in endocrinology.  Since I suspected that my issues went a lot farther than, “You’re fat, Sarah.  Quit eating ice cream and get off the couch!”, I needed to find someone who could help sort me out.

I started by consulting Google.  After all, my 5-year-old says, “Google knows EVERYTHING!” The Paleo Physicians Network and Jimmy Moore’s list of low-carb doctors were immediately useful.  While there weren’t that many options in Indiana, I had no trouble narrowing it down to two choices.   One guy was an integrative medicine doc who’s passionate about the Paleo lifestyle.  The other doctor was low-carb friendly and specialized in issues like obesity, diabetes, PCOS, thyroid, and more.  The choice was tough because the Paleo guy was closer to me and he accepted insurance whereas the other guy was a lot farther away and runs a cash-only practice.

In the end though, I picked Dr. Andry over at Andry Medical Services, and I absolutely believe I couldn’t have made a better choice!

My first appointment was scheduled for February 25.  I was excited, anxious, and hopeful.  Less than a week before my scheduled appointment though, I got a call from Dr. Andry’s office.  They needed to reschedule because Dr. Andry had to attend some sort of conference up in Indianapolis.  They moved my first visit to March 11, and the waiting was agony!

I was so impressed after my first visit.  Dr. Andry was patient, kind, intelligent, and funny.  He seemed passionate about low-carb eating, and as a bariatric physician, he had other great insights that I frankly hadn’t expected.  He renewed my blood pressure meds (which I desperately needed but did NOT want to get from my internist), he started me on Metformin (which was no shock), and he added another drug that was supposed to help decrease my appetite.  He ordered some labs, and he scheduled another visit.  Oh yeah, and I got weighed of course! My starting weight was 263.8.

Getting used to new medications made for a rough few months.  I knew there’d be an adjustment period to the Metformin, but I didn’t expect that everything would be so hard.  We ended up dropping the med to suppress appetite because I couldn’t think clearly, and it ended up giving me migraine symptoms without the pain.  I wasn’t willing to accept those side effects.

Many of my labs weren’t surprising.  Although my cholesterol was “high”, my triglycerides and HDL were nearly identical.  They both ran near 70, so I was pleased there.

My TSH showed that I could probably benefit from some Armour Thyroid, so I got a prescription for that.

What surprised me more than anything about my labs though was my HbA1c.  It was 8.3%! When Dr. Andry told me, you could have knocked me over with a feather.  No more could I ignore my blood sugar issues.  I knew that number put me solidly in the diabetic range, and I was shocked and scared.  (As an aside, I was even more stunned when I found an online chart that converted my A1c to an average blood sugar of 192 mg/dL.)

Dr. Andry was quick to re-assure me though.  He reminded me that we’re in this together, and he was confident that we could move things in the right direction.  Still shocked by the bad news though, I wasn’t so sure.

At that visit, Dr. Andry also gave me a trial of another diabetes med — and injectable called Victoza — and he sent me on my way.  It was after THAT visit that things started getting interesting (and REALLY hard.)

The Victoza combined with 2 grams of Metformin per day was too much for my body to take.  I was SO sick.  In fact, I lost like 14 pounds in the first week because I COULD NOT eat.  The nausea was too much to bear, and I started to get really depressed.  Also, since I wasn’t hardly eating, when I DID eat, I didn’t care if it was on plan or not.  So much for the worries about my blood sugar.  I just wanted to feel better then, and I was thinking about dealing with my food choices later.

When I couldn’t take it anymore, I called Dr. Andry’s office and talked to the nurse practitioner.  She suggested that I back off on my Metformin and see if that lessened the symptoms, and sure enough, that was the ticket.  I definitely noticed a decreased appetite from the Victoza, but since I’d lost all that weight from feeling so sick, I still didn’t care too much about my food choices.  In the end, even though I was pretty calorically restricted, I still only managed to lose 4 pounds from April 15 to May 20.  (Yeah, I’d lost a decent chunk, but I retain water like mad when I eat carbs.)

All during this time too, my mood was in the toilet.  Between the news that I couldn’t hide from diabetes anymore and the medication side effects, I was having a hard time.  And since I was feeling so low, I wanted to eat sugar to feel better.  Of course, that’s the LAST thing I needed, and I knew that, but at the time, I didn’t really care.  The whole time, I kept thinking, “When these side effects get better, when I start feeling normal, I’ll manage my food.” But of course the poor eating was likely contributing to the emotional stuff.  It was just hard.

Oh! And if all that wasn’t enough, I passed out in public and earned myself a trip to the ER.  Yep.  That’s right.  For the second time ever, I passed out, and it really caused quite a scene.

See, my friend and I had gone to a local mobile food pantry.  I was in a hurry to get out of the house, so I didn’t grab any water.  We jumped into her truck, ran over to Columbus, and got in line to receive our share of food.  It was a hot day, about 90 degrees, and we had to stand in a parking lot.

At first, it wasn’t too bad.  There was a nice breeze blowing and we managed to find shade.  After we’d been out for about 45 minutes though, I commented on how it MUST be hot because I was sweating and I have to be HOT to sweat.

We noticed that folks were getting a cold bottle of water with their food stuffs, and Jen and I chatted about how we couldn’t wait to get a drink.

The line moved around the truck so that in short order, we were standing in the sun and we felt no breeze.  After another 30 minutes or so, we were almost to the sign-in table though.  I started to feel sick to my stomach, so I tried distracting myself.  I took some deep breaths, and I started telling myself, “You’ll feel better when you get the water, Sarah.  Just hang on ’til you get to the water.”

The distractions weren’t working though.  Before I knew it, I found myself overcome by nausea.  I started to look frantically for a place to step out of line so I could have a tiny bit of privacy while tossing my cookies.  Before I knew it though, intense dizziness caused me to crouch down.  (If I was going to pass out, I didn’t want to hit the deck from a standing position.) I had planned to just steady myself there ’til I felt well enough to move forward, but it didn’t quite work out like that.

Jen asked me if I could move forward with the line.  I recall saying, “Yeah,”, and I recall trying to stand up.  I also vaguely recall hearing something about a chair, but the next thing I knew, I was sitting in a chair with people all around me.  It seemed like they were all talking REALLY loudly.  Some folks were trying to find ice.  I recall hearing that someone had called for an ambulance, and several folks were trying to keep me from falling out of the chair I was sitting in.  There were a lot of folks telling me to stay calm, but I wasn’t feeling agitated.  I just felt extremely disoriented and really, really sick.

I don’t think it took much time for the ambulance to get there.  They packed me up pretty quick, loaded me into the ambulance, and started doing what they needed to do.  They checked my vitals, of course.  My flood pressure was still really low.  They tried to draw some labs, but that didn’t work.  They did manage to get an IV started though.  (I still have the remains of the nastiest bruise ever, and this all happened two weeks ago tomorrow.)

When I got to the ER, they did all the usual stuff.  It took quite a while for them to go get Fred out of the waiting room though.  (Jen called him at work.  He came to the parking lot while I was in the ambulance, and then the two of them drove to the hospital to wait for me.)

In the end, all I learned is that my kidneys were showing signs of extreme dehydration.  The ER doc told me to stay inside the next day, hydrate, and come back in 3 days to get more kidney labs drawn.  That way, when I had my appointment with Dr. Andry on June 17th, he could have those labs so we could change meds or whatever.

By the time my appointment rolled around, I was feeling better, but I was still really struggling with dizziness and blacking out whenever I’d stand up.  My labs hadn’t made their way to Dr. Andry though, so he couldn’t review them at that appointment.  He did, however, add another medication (specifically for weight loss), and he cut my water pill dose in half.  I thought that’d be enough to get me feeling better, especially since the weight loss med is a stimulant, but so far, no such luck.

The doctor also gave me a script for a higher dose of Victoza since it DOES work (on both my appetite and my blood sugar), but even with the Victoza savings card, my script was going to cost almost $200 per month.  There’s no way I can swing that!

On a positive note though, I’ve been sticking to a low-carb eating plan, and weight’s been melting off with the addition of the phentermine.  I weighed 247 today which means that I’m down 16.8 pounds since March 11.  I’m still really struggling with the effects of low blood pressure, and if I can get that whipped, I’ll feel really optimistic.  I knew this wasn’t going to be easy, but I certainly didn’t imagine that I’d struggle this hard for this long.

Despite everything I’ve mentioned in this post, I’m actually not a whiner.  Until my trip to the ER, I was so used to “pushing through the bad” that I didn’t really know much different.  Now though, I’m not taking any chances.  It probably seems like I’m being overly sensitive to some, but I’d rather stop too soon than stop because I’m on the ground waiting for an ambulance.  Again, that was NOT something I ever hope to repeat.

The good news is though, I AM making progress.  I’m getting excellent care and direction from my doctor, and I’m headed in the right direction.  I’ll try and keep updating on Mondays, and I’ll try to remember that even the setbacks are worth sharing.

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