Monday, July 25, 2011

Mirena IUD for endometrial hyperplasia (TMI warning)

Ok,most of my facebook friends don't want to hear more about this, so I will write here, where I am more writing to myself.  I want to pull the whole story together, for reference 5 years down the road.

I used a diaphram for birth control my whole fertile life, so I experienced a natural menopause (quite different from the menopause experience of people taking birth control pills).  It is a long process.  During my last couple of years of perimenopause, I had very heavy periods.  Even the highest absorbancy protection lasted less than 2 hours at times.  My doctor suggested ablation, but I didn't want to do anything that dramatic--I figured it would end eventually.  With what I now know, I think I should have been on some kind of progesterone treatment then.

I had what I hoped might be a last period in the summer of 2008, then none for almost a year, then several a little under a year later in the summer of 2009.  Then I had nothing until the spring of 2011, when I had what seemed like a normal period.  I knew that since it was more than a year I needed to have it evaluated, so I went right in for an ultrasound.  That showed that the lining of my uterus was too thick, endometrial hyperplasia, so the next step was an endometrial biopsy.

The good news was that the biopsy did not show abnormal cells, but the thickening still needed to be treated before it did turn into abnormal cells.  Having avoided birth control pills all my life, I didn't want to start taking progesterone pills, so I like the idea of the Mirena IUD, which releases progesterone where it is needed.  My doctor agreed, so we started the process of ordering one.

The distributor for the Mirena is CVS Caremark, which tried to bill my insurance and was told that the Mirena isn't covered.  It turns out that it is covered, but under medical rather than under pharmacy.  My doctor wasn't willing to order it at their expense and then bill insurance, so I ordered it on a payment plan and then will file for insurance and pay when the insurance pays.  It finally showed up at my doctor's office last week, nearly two months after the biopsy.

I was told to take two Aleve before my appointment, and I arranged for my son to drive me.  The doctor had told me that some people find the biopsy easy and some people find it very painful.  I found it trivial so I was optimistic about the IUD insertation.  I think I talked the whole time about concerns about my kids--it did hurt some but I was trying to distract myself.  It was more like bad menstrual cramps than like labor, though with some sense of being painfully poked inside, particularly in the step that measures the depth of the uterus.  Once it was done I was just glad it was over, though I had cramps still.

My doctor said to me "You're a tough woman."  That was really the first time she had admitted that the procedure is pretty painful.  I said "I had a 10 lb 1 oz baby vaginally with an epidural that didn't work."  Yes, I'm tough, and proud of it.  I went home and rested a while then took my husband to his doctor's appointment.  I made dinner, but I was significantly uncomfortable with cramps.  About 6 hours after the procedure they suddenly got much better, so I'm hopeful they're over.

If all goes well I will have another ultrasound in 5 months to see if my uterine lining is back to normal.  But what my doctor doesn't know and I can't find discussion of is how it will get that way. Will it bleed off, in one giant period or gradually over a long time?  Or will it reabsorb without significant bleeding?  My doctor was hopeful that might be the case.

Update in early October:  I had light spotting for about two months, but now it seems to have stopped.  I had a lot of difficulty getting my insurance company to agreee to pay, but that has been because it falls between medical and pharmacy and each said the other would handle it.  Supposedly it is now worked out, but the check hasn't come.

Saturday, July 23, 2011

Baseball bat sized Zucchini

On impulse at the Pendleton farmers market, I bought a baseball bat sized zucchini.  The seller said the ones they had cut did not have mature seeds, but I picked one of the biggest ones (over 4 lbs) and it did have mature seeds.  So I peeled it and scooped out the seeds and grated it--I've got at least 6 cups of grated zucchini. 
   I wanted to make a richer chocolate zucchini cake than the recipe that uses cocoa powder, so I started from a recipe at Scandi foods and modified it into:

Reduced Carb Chocolate Zucchini Cake
2 cups grated zucchini
1 cup walnuts, coarsely chopped
1 cup almond flour
1 cup white whole wheat flour
1/2 cup vital wheat gluten
2 tblsp unsweetened cocoa powder
1 1/2 tsp baking powder
1 tsp baking soda
1/4 tsp ground cardamom
1/4 tsp ground ginger
1/4 tsp ground nutmeg
6 oz 70% dark chocolate
1 cup brown sugar
4 large eggs
1/2 cup butter, melted
1 tsp vanilla extract
2 tblsp strong coffee
3/4 cup buttermilk

Preheat oven to 350 and spray a large bundt pan.

Squeeze excess water out of the zucchini. Sift the dry ingredients, except the sugar and almond flour, into a bowl. Melt the chocolate and butter together. Using electric beaters, beat the eggs and sugar until light and fluffy. Beat in the chocolate-butter mixture and the vanilla and/or coffee, then the almond flour. Fold in the flour mixture and the buttermilk. Lastly fold in the zucchini and walnuts.

Pour the batter into the bundt pan and bake for 60-70 minutes or until a a skewer comes out clean. Leave to cool on wire rack before removing from pan.

I'm planning on zucchini pancakes for dinner (eggs, flour, cornmeal, parmesan) but that still leaves me with enough grated zucchini for another recipe.

Family caregivers: the different issues of spouses and children

The Lewy Body Dementia Association sent out a newsletter that included a short article on "Five Questions Caregivers Should Ask Themselves."  One of the questions was:
  • Do you have a supportive spouse or partner, a negative partner, or no partner? How does this relationship affect your caregiving and how does your caregiving affect your relationship?
Wait a second.  What about those of us who are caregiving for our spouse/partner?  Can you imagine the lack of support then?  I get so frustrated when I go to read an article about caregiving and it speaks only to the issues facing children caregiving for a parent.  Maybe the answer is separate groups: on Yahoo there are separate support groups for Lewy Body Dementia for spouses and for other family caregivers.  Half-seriously, I suspect that is because the children couldn't stand to read the spouses writing about what to do about sex.  Another group I find helpful because it addresses the issues of spouses is The Alzheimer Spouse, which includes lots of spouses dealing with other kinds of dementia as well.

I want to say some things to children caring for parents.  First, if you are sharing caregiving with your parent's spouse (whether that person is also your parent or not), think about that person's right to make their own choices even if they are not the ones you would make (go read this article about knowing what is best for another person).  Watching the decline of a parent and of a spouse are both great griefs, but they are different griefs.  Try not to be so caught up in your own grief that you don't see how it is for the spouse.

If you write about caregiving in a forum not specifically oriented towards children caregiving for parents, please acknowledge that many caregivers are spouses.  And we may be your age.  I'm 56, caregiving for a 65 year old husband in the early stages of Lewy Body Dementia.  I know women in their 40s with children still at home caring for husbands with early onset Alzheimers.  We may be working full time; we may have dreams of what we were going to do in this stage of our lives that have been crushed.  Don't leave us out of your discussions and resources.

Thursday, July 21, 2011

Birth control blog carnival

I want to celebrate the decision to recommend that insurance cover birth control--see the blog carnival here--and throw in my own experience.

These days I have the sense that people assume birth control means the pill, but there ares other alternatives. I tend to be sensitive to the side effects of medication, and I didn't like the idea of taking a pill every day when I didn't have sex every day. So I used a diaphragm, from when I became sexually active in the mid 1970s until menopause a few years ago. It is a plenty reliable method if used well--I never had an accidental pregnancy, even though when I decided to get pregnant I conceived the first month of trying.

Now I'm post menopausal but I'm going to get a progesterone-releasing IUD soon to treat endometrial hyperplasia. My insurance company, interestingly, covers birth control for the subscriber and spouse but not for dependents. I suspect that is a moralistic position, as dependents are pretty much by definition unmarried.  But at least the IUD is on their list of things they cover for me, though in an awkward way that took many phone calls to figure out.

It is a pity that people don't consider other options than the pill. Given the tendency of the pill to cause weight gain and my experience of pregnancy, I'm glad I didn't complicate my long term trends with the pill.

Sunday, July 17, 2011

Changing up my way of being healthy

I was diagnosed with diabetes in the fall of 2003.  I quickly found the low carb tight control approach, and gradually began to exercise more seriously, as I realized that I could eat more carbs if I exercised afterwards.  In May 2005 I did my first triathlon.  In September 2007 I did my longest race, a half-ironman.  I signed up to do the Beach to Battleship iron distance race the following year, but life got in the way of training and I gave up the idea several months beforehand.  The combination of a low carb way of eating and exercise kept my A1c in the range of 5.6 -5.8 for most of those years without any medication, and I loved being an athlete, enjoyed the training immensely.

I did one sprint triathlon last fall and another this spring, but I haven't been keeping up my training very much.  I still feel healthy, but my clothing size has crept back up almost to what it was when I was diagnosed.  I try not to care, but I miss other people seeing me as healthy.  A year ago my A1c was up to 6.1, which I thought problematic, though to my surprise this year it was down to 5.8--my way of eating works!  I'm lucky in my genes--my HDL chloresterol is naturally high (around 80) and my triglicerides naturally low (in the 30s), but my LDL is mildly high and has been creeping higher.  In the past year I tried to bring my LDL down by adding oat bran to my morning smoothie and taking a garlic supplement, but it didn't work.  I am not willing to take statins--I'm not willing to take the risk of muscle damange or memory loss. 

So I began to consider the idea that what had worked for me so well for five years wasn't working as well any more.  I loved being a triathlete so much and I had felt such pride in finding a way of being healthy that worked for me (without medication!) that it was very sad to admit that it wasn't working any more and consider a change.   I love being outdoors so much, but with less time flexibility now because of John's illness, too often the weather or other commitments get in the way.  And I find it hard to be really dedicated if I am going to be interrupted regularly--if I take a dedicated approach then the interruptions are too frustrating.

I had two ideas for a new way of being healthy.  One is an exercise machine at home, so exercise is more flexible and less of a time commitment.  The other is to go on diabetes medication, because there is a fair bit of evidence that metformin has a wide range of benefits and few downsides (unlike most diabetes medications).  I began to see things differently.  My old way of being healthy worked wonderfully for me in that stage of my life, but change is good, both for freshness and because the once the body gets used to a pattern there is less benefit.  Instead of thinking that I had found what worked for me once and for all, I might try a perspective that every five years I will change my way of being healthy.

So last week I started my new approach.  My exercise machine came Tuesday in a large box on a pallet, and thanks to a young man who works for me sometimes, it is set up.  I'm trying not to overdo it but I am enjoying using it to walk while I read blogs on my iPad.  I would be happy to get on it several times a day, but at this point I clearly need to be careful not to irritate my achilles tendon.  I like the motion of the hybrid elliptical/stair stepper a lot. 

The first couple of days I took metformin I noticed a little stomach discomfort, but that has faded quickly and the main difference I notice is that I feel more energetic--so much so that I have just switched to taking it in the morning instead of at night.  Some people have terrible digestive problems from it, but I didn't expect those because I am lucky enough to have a cast iron stomach.
I'm keeping a few pieces of my old way of being healthy. I'm still going to swim regularly and run/walk when I feel like it.  I'm dropping the garlic and an acai/berry supplement, but I will keep on with:
  • oat bran (on the theory that the fiber is good for me even if it doesn't help my cholesterol)
  • a supplement called serenity formula which I found reduced the impact of stress on my blood glucose
  • a calcium/magnesium combination with trace minerals (I only take one instead of the recommend dose of 4)
  • 2000 IU of vitamin D3
  • fish oil (which seems to reduce my mild hot flashes)
I will also add Vitamin B12, which Metformin interferes with. I'm convinced by the argument that the methyl form is the best.

I have one more piece to put in place--the treatment I have chosen for my benign thickened uterine lining is an IUD that releases progesterone. Figuring out how the insurance would work was a major enterprise, but it is on its way and my doctor's office will call to set up the appointment to put it in when it arrives. I actually have had symptoms of estrogen/progesterone imbalance for years so I am hoping that if I feel any differences they will be to the good.

I'm excited to be making a new start!

Saturday, July 09, 2011

internet issues

I've been having trouble with the internet of our ATT Uverse system. Oddly, some of our laptops worked fine with it, but my daughter's Levono and my iPad lost connection with the internet a lot.  It got to the point where my iPad would download my mail, but anything else I tried to do got a "not connected to the internet message."  I chatted with a representative, who "refreshed the lines" and now it works, though they wouldn't admit there was any problem with the line.  They now tell me to put the cordless phone further from the router, though they put the phone jack right next to the router.