I need to rant, so here it is:

I had a new client today that just made me want to bang my head against a wall. Well, actually, it was her 14-year-old daughter who brought the dog in (and good for her!). The pet is a 2-year-old Yorkshire Terrier. She "broke her water" last night, and had been having contractions for 5 hours by the time she presented. A dog usually starts pushing and has delivered all her pups within 2-3 hours. Once two hours pass with no puppy produced, it is considered an emergency. 

Anyway, this dog was pushing to no avail, so the poor little girl started calling vets. I told her to come in so I could at least examine the poor dog. When she gets there, she tells me she has no money. I told her she needed at least the $57 dollars for the exam and then I decided (because I am nice) to give her a free exam. Well, the dog was fully dilated, and I stuck my finger in the vagina and felt a very large head. Not good. Especially when having no money. I told the girl I really needed to speak with her mom.

I talked to mom on the phone, who was apparently at work in another town, and quoted her about $2000 if the dog needed a C-section, because she was going to need pre-op blood work, IV fluids, pain meds, emergency surgery, and aftercare, etc. I suggested she apply for Care Credit. She told me she knew she would get turned down, and so she would, "just take her home to die." I told her absolutely not--I would not allow her daughter to take the dog home to die a horrible death, and if that was all she wanted to do, I could euthanize her. So she told me to do what I could with a grand total of $80.

Now, two views of the abdomen cost over $150, but I needed to know what the situation was, so I told the girl I would take the X-rays for her $80. There was one HUGE monster of a pup, and there was no way in hell this 4-pound dog was going to pass it through the birth canal.

So I explained she was going to need a C-section and asked the girl if there was anyone at all in her family or circle of friends who could give her some money, because I can't give my services away for free. That's when her prize of a boyfriend decides to tell me that I obviously don't care about animals, and he cannot understand why, if I care about animals and am supposed to take care of animals, I can't just do the surgery for free. JUST. DON'T.

So I then told him, "I cannot care for your dog more than YOU care for your dog. It was completely irresponsible of YOU to  breed her without putting away enough money to take care of her, should she have complications such as this. YOU are the one who put her in this position, NOT ME. Would you expect a mechanic to fix your car for free because you need it to get to work? No? Then why do you expect me to fix YOUR problem for free? Do I not deserve to be paid for my services, too?"

Well, he shut up at that point, and I went to figure out what I COULD, in fact, do to relieve this dog's suffering. In the end, grandpa came through and offered to pay for the C-section. I sent them to the ER down the road, because by the time they came up with the money, I was covered up in appointments and couldn't get it done in a timely manner. And I got a grand total of $80, while she got a set of X-rays, my expertise, an exam, and a lot more compassion than those people deserved.

I sincerely hope they got the dog through surgery. And I sincerely hope they learned you DO NOT BREED A DOG IF YOU CANNOT PAY FOR A C-SECTION.

We just can't do it. No matter how well behaved, nineteen animals is still nineteen animals. While I appreciate that pet owners can be very responsible (see self), I also know that my four dogs, three cats, and one rabbit do take a toll in wear and tear on a house and yard. Double that and then add THREE more on top of the DOUBLING of my own crew, and, yeah. 

Or rather, NOPE.

That is the number of pets the family wanting to lease our house has in their possession. NINETEEN. I said pets were welcome, but come on! NINE dogs and TEN cats. Wow. I mean, I have four dogs, 3 cats, and a rabbit, but they more than double that!

Wow. We need a renter badly. I just don't know we need one THAT badly. I don't know. They were SO nice. And they have a boy with Asperger's and another with ADHD (who were both very well-behaved and polite). I liked them. Hell, LEGO liked them, and that's rare.

But NINETEEN animals? I don't know if I should even consider it.

Read it. http://www.boston.com/lifestyle/family/articles/2011/12/11/led_by_the_child_who_simply_knew/?page=full

I am always amazed by people who can't/won't understand transgenderism. Countless examples in the animal world proving this occurs naturally don't seem to sway them. Maybe just reading about this little girl and her family will open ONE mind. 

Got the results of my free T3 today:  1.7 of whatever unit of measurement with a reference interval of 2.3 to 4.2. Praise be to the god of your choice, I finally met the lab criteria for a diagnosis of hypothyroidism. 

Of course, this is the test my doctor only ran when I refused to accept the supposedly "normal" results of my free T4 (which was decidedly not normal, but whatever). She said it would be rare, but that sometimes people don't convert T4 to T3 efficiently and maybe I was one of them. Anyway, the end result is she finally agrees with me that all of my text book signs do indeed warrant a diagnosis of hypothyroidism.

Thankfully, she IS on the ball with regards treatment and put me on liothyronine, which is T3, NOT T4, since that seems to be my major deficiency. I am still concerned about why my TSH is so markedly low when it should be HIGH with my other results, but I will save that for another discussion with her.

Let's just hope I get to feeling better soon.

That's right! I did not need ANY naps today! This stuff is working, I tell you. Also, I went running--2.95 miles. I did the first quarter mile barefoot, just because I was curious what it would feel like, then I put my shoes on. It felt amazing, actually, but I did not want to tempt fate, so shoes it was. 

I cannot tell you how happy I am to be reporting the lack of a need of a nap. 

So, as I said in a previous post, my thyroid functioning is not what it should be. Of course, my doctor does not agree, and the reasons for that are many. First, there is this stubborn refusal in the medical community to move past the "traditional" lab values used for years that have since been invalidated by the American Association of Endocrinologists. Yes, that is correct, the very association of doctors who should know what normal thyroid functioning is have decreed that the values we have used for years and years are, well, not correct. Yet many labs and the doctors that use them still go by the old numbers. 

Secondly, while the "typical" reason for low thyroid functioning is that the gland itself is not producing enough thryoid hormone, that is not the ONLY reason. Yet when a patient presents with almost a textbook case of low thyroid functioning, if the lab values show a "normal" thyroid hormone level, most doctors simply stop looking at the thryoid as a reason for the clinical signs. This makes no sense, as not every patient's body reads the text book.

I don't promise to be able to explain this in a way that the lay person can understand, but I am going to try. At the base of the brain sits the hypothalamus. This little piece of the brain functions somewhat as a gland, in that it sends out neurohormones. In our little story, it sends out Thyrotropin Releasing Hormone to the pituitary gland, the "Master Gland" of the endocrine system. The pituitary gland then releases Thyroid Stimulating Hormone to the thyroid gland. The thryoid gland is kind of the Universal Remote Control for metabolism. It controls how fast or slow everything occurs in the body--temperature, digestion, cell reactions, metabolism of everything. So if the thyroid gland is sluggish, well, everything in the body, and I do mean everything, is in slow motion. A person feels cold, mentally foggy, cannot stay awake, digestion slows down, the body temperature is low, hair growth is disrupted and so hair falls out, nails become brittle and break, skin is dull, the whole metabolism slows so you gain weight, your heart rate is slow, you lose your sex drive because your other hormones are affected, menstrual irregularities and infertility can occur, basically, you are a slug. When the thyroid is over-functioning, everything speeds up: you have a higher temperature, the heart beat is fast, your thoughts race, you can't sleep, you can't keep weight on, you are hungry all the time, etc. etc. 

Anyway, the typical test for thyroid functioning done by your doctor is the TSH (thyroid stimulating hormone). In hypothyroidism, in many cases, if your thryoid gland is not functioning, then your pituitary gland responds by cranking up the TSH and so this number will be HIGH. This is important to note. If your thryoid gland is over-functioning, as in hyperthyroidism, your pituitary gland shuts off TSH in an effort to get the thryoid to STOP making T4 and so your TSH will be LOW. 

The other test they sometimes run is your free T4. Most of your T4 (which is the short name for thyroxine, one of two thryoid hormones) is bound to proteins in your blood. The "active" form is "free" of these proteins, so this is a more accurate reflection of what is actually available to be converted to T3 (triiodothyronine), the truly biologically active hormone. When your doctor tests your free T4, if you are hypothyroid, this value is expected to be LOW. 

So, in a nutshell, with the traditional form of hypothryoidism, free T4 should be LOW, and the response of the pituitary gland would be to crank up production of TSH and so TSH should be HIGH. In MY case, BOTH free T4 and TSH are LOW, just not low ENOUGH to make my doctor think there is a problem. 

Aside from the fact my free T4  actually IS below the normal reference for every lab in the country I contacted and the one they use seems to be considering my value normal based on reference ranges for a normal PREGNANT woman (and I assure you, I am not pregnant), my TSH is in the extreme low end of normal. It is almost sub-normal, and this alone, should alert my doctor, because this value SHOULD correspond with a HIGH normal T4. It is a value usually seen in a HYPERthyroid patient. 

So, how can this happen? Well, there are a couple of scenarios by which this can occur. One is called Central Hypothyroidism, and this is the one my doctor SHOULD be considering. Central Hypothryoidism means the problem does not lie in the thryoid gland itself, but rather in either the pituitary gland or the hypothalamus.The problem, as it were, is that the Thyroid Stimulating Factor is not being released in enough quantity to generate enough T4. And given the mysterious advent of almost daily severe migraine headaches, some of them with visual disturbances and facial numbness and all kinds of signs I have never before had with my migraines, I think I would be quite concerned, were *I* my doctor, about what might be going on inside my patient's head. But what do I know? I am *just* a veterinary medical doctor, and I *just* deal with endocrine diseases in about eight other species, non-human.

There are other reasons for these lab results, as I said, but I am tired of typing, so I will leave them for another post. If you've read this far, I hope I managed to make this make sense. If not, let me know, and I will try to do better.

This will be a chronicle of my battle with some recent health issues. I am posting it mainly as a record for myself. If you feel like reading along, more power to you, but it is not expected. Feel free to comment or make suggestions, as you wish.

Shortly after my graduation from vet school, so around the first of June, I developed a rash on my torso that some attributed to the hot tub, others to a river rafting trip, and still others to reasons unknown. It doesn't really matter. The long and the short of it is that right after this rash, my life changed. Something in my immune response to whatever it was went wacko. My previously extremely high energy level came crashing down. The woman who was spending her post-vet school days arranging the kitchen, taking cello lessons, going to the gym, training for a 5K, making jewelry, planning a vacation, and so on, while also working part time and feeling bored, suddenly could not find the energy to get up out of a chair and unload the dishwasher. Just planning meals took too much effort. Thinking beyond just putting on my gym clothes, going to my work out and then coming home to nap was exhausting.

And then there was the weight gain creeping up. I started at my gym just after graduation. I have never been a dieter. I am of the belief that in order to burn calories, you have to consume enough of them in the first place. I don't deprive myself, but I also make sensible and healthy choices. So it was mystifying, to say the least, to be going to work out with a professional trainer three times a week, doing weight training to build muscle, and then on my alternate days running 2-3 miles at an aerobic pace (keeping my heart rate in a fat burning zone, not a glucose burning zone), and yet, instead of losing weight, or inches, I was gaining them. And before you say it was muscle, I assure you, it was NOT. Over the course of 3 months, I gained 12 pounds of fat. My pants got tighter, not looser (with muscle, you get leaner, not plumper). Muscle does not look like cellulite. And all the while, Alan was working with the same trainer and losing 27 pounds, so I can't blame the trainer. Nope--something did not add up.

And my moods, oh, my moods! I was getting so ANGRY all the time. And when I wasn't angry, I was lethargic, or just...apathetic. I went from being someone who cared VERY much about the appearance of my house to being someone who just didn't give a fuck if the house was falling down around me.

And my sex drive, well, let's just say I could be the president of the Asexuals of America right now. I don't care what it looks like, male or female. I am just. not. interested.

My eyes got puffy and my eyelids swelled up. My normally soft and shiny hair became brittle and frizzy. My fingernails became ridged and brittle. My skin began to crack in regions no one should have cracks. My thinking became fuzzy, words became difficult to process. And the migraines started to come daily. I took FIFTEEN maxalt in a single month, and that's only because I ran out of them.

So I did what any sane person would do. I saw my doctor and told her something was horribly wrong. But of course, telling your doctor that you have gained weight when you are still what many people consider thin, well, that just gets you a pat on the head. And saying you have no sex drive, are moody and that you just feel WRONG all the time, when you are 45, well, that just gets you a, "well, of course, you ARE a woman of a CERTAIN AGE." So I did the hormone tests, and they show that I am not in menopause. And as far as my doctor was concerned, that was that. But she put me on topamax, and that helped the migraines, so she was happy. But I was still WRONG inside.

I did some reading and became convinced my thyroid gland had taken a swan dive. I began recording my basal temperature every morning before getting out of bed. MUCH peer reviewed literature shows that basal temperature is the most reliable indicator of thyroid function. Well, my basal temperature every single morning for the last 6 weeks was between 96.1 and 96.4 F. Anything below 97.6 is a pretty good indication of hypothyroidism. AHA! I figured now that I had this information, along with my long list of CLASSIC symptoms, I could tell my doctor this was the problem we should test for.

Well, she agreed to test, but I could tell she was skeptical. She did not do the full thyroid panel, though she should have. But she tested my TSH and my free T4, and both came back very low normal. So she interpreted that to mean I am normal. Well, let me just say that is not accurate. You see, if one has a low level of thyroid hormone (T4), then one should have a higher end level of TSH (thyroid stimulating hormone) because the pituitary gland should be signaling the thyroid gland to wake up and stop doing such a crappy job. Never mind that taken by itself, my T4 is actually low enough to be considered hypothyroid by every lab in the country EXCEPT, apparently, the lab my doctor uses. All I know as a veterinarian is that if I were a dog with my clinical signs and these lab results, I would be very suspicious of central hypothyroidism, ESPECIALLY given the sudden onset of severe migraines with ocular manifestations. But I am not a human physician, so I have to play the game.

So, I then requested a T3 test and anti-thyroid antibodies. They consented only to the T3. I am not sure why. Whatever. I am still waiting on those results. In the mean time, my GI system has completely rebelled. I think the sub-optimal body temperature has messed up my digestive enzymes. I can no longer tolerate lactose at all. I went off dairy completely and was doing great. Then last week, something else, though I have NO clue what, upset the whole apple cart again. I spend my days, and nights, bloated, full of horrible, FOUL gas, have to use the bathroom at least ten times a day, and in general am just not a happy camper.

So, to that end, I am trying an elimination diet of sorts. Tomorrow I am going to try to eliminate all gluten, dairy, amines, most salycilates, and soy. I am already vegetarian (and that is not an option to change, so don't suggest it). I can't eliminate fructose just yet, but will if I have to. For the next few days, I am going to try to get by on rice, coconut milk, sweet potatoes, vegetable broth, pears,and some low salycilate, low amine vegetables and fruits. I need to find a source of protein, and may try eggs, but I am not sure yet how I react to them. I think tomorrow I will go egg free. If my gut clears up completely, and I do mean COMPLETELY, I may try an egg. I know I cannot eat this way for long, and I know it is not balanced, but I HAVE to give my digestive system a rest and then add back one food at a time. Here's hoping.

Well, it appears the storm knocked out power at work, so all my worrying was for naught. Surgery delayed. I shall use the delay as an opportunity to practice my suturing and visualize my procedure.

In storm-related news, my tree was victimized: