me and my illness

So, I wanted to give a voice to the reason that I am currently incorporating bioidentical hormone therapy into my practice.  For those of you who don't know what that is, I'll be writing more about it in the future, but you can satisfy your immediate curiosity by checking out the following websites:
bioidentical hormone society
http://www.ucprx.com/
http://www.a4m.com/ (this is where I have gotten my most recent board certification)
Suzanne Sommers and Dr. Oz also discuss this quite a lot.

The journey begins in November or so 2009. 

I have to start by saying that I am I high stress person.  I always have been.  My mom wouldn't let me watch the news or anything with disturbing images because of my anxiety.  I've always wanted to save the world and everyone in it.  When I was small and thinking globally, I had a hard time coping with not being able to fix it all.  I guess to a certain degree I still do.  Anyhow, I'm medicated with a serotonin/norepinepherine reuptake inhibitor, and this generally keeps me from going completely crazy. 

Anyhow, in November or December last year, I started to feel tired.  I chalked it up to being busy and doing a lot with my kids.  I figured that when winter rolled around in full force, I'd feel better.  Unfortunately, it only got worse.  At one point I'd hit my head pretty hard, and I started to think that I might have post concussion syndrome.  In February, we had a trip to Disney (my happy place) planned, and I got pneumonia before we left.  We went anyway, because I feel that I can be sick at home or sick at Disney.  Either way I'm sick.  At least there I'd be sick and happy.  So, we went.  When I came back, things really took a turn for the worse.

Over the next couple of months, I started being unable to do much of anything at all.  I had stopped sleeping in my bed because I couldn't make it up the stairs to my bed.  I had stopped driving, because I couldn't concentrate to drive.  I had dropped out of all of the kids sporting and scouting because I didn't have the energy to do it.  I was going to bed at 6-7pm every night and having a hard time getting up in the morning.  I usually napped at lunchtime.  I had also gained 50 lbs over the previous year.   Towards the end of April or May, I had gotten out my disability paperwork and my life insurance paperwork.  I was pretty sure that I was dying.  I was absolutely sure that I couldn't continue to see patients anymore on a daily basis.  I was completely unable to complete a thought, and could not concentrate on anything that my patients were saying.  One day, I had an RN in the clinic as my patient.  She looked hard at me and said, "Dr. Chua, you shouldn't be seeing patients like this - you're not making any sense."  I think some people thought I was on drugs. 

During this time, I was seeing my local practitioner.  I love him.  He's a great clinician - I have sent my parents to him as well.  I had about 15,000 dollars in testing and everything came back normal.  Believe me, I know that when things feel terrible, it's hard to be told that everything is normal.  You WANT something to be wrong so that it's not all in your head.  You NEED a diagnosis so you can start leading a normal life again.  I really, truly felt that I was going to die before the end of the year and no one could figure out what was wrong.   The basic answer was - "you are under too much stress and it's taken it's toll on you.  You need to cut back your hours at work and you need to quit drinking wine."

Understand that Phil and I own our practice.  We are in debt - like 500,000 dollars worth from our start up and taxes.  We don't pay ourselves a salary from our office. We operate on a bare bones staff because we can't afford anything else.  If I cut back my hours, that would mean shutting the practice down because we wouldn't make enough money to justify keeping it running.  That caused a little stress....

So, here I was one morning.  Phil had dropped me off to work, but I was so weak that he actually had to help me in the door.  I sat down on the couch in our office.  Actually, I was too weak and tired to sit, I had to lay down.  Then, I couldn't get up.   I just couldn't.  I laid there and cried for what seemed like an hour.  I had the girls cancel my patients that day because I couldn't get up.  Right at that moment, another physician called.  She'd heard I'd been feeling bad and wanted to know how I was.  I could barely talk to her because I was crying so much.  She told me that she'd been to a wellness center in Texas and that their motto was, "People don't lie, labs do."  She told me that I should start on thyroid hormone NOW. 

At this point, I was willing to do anything, so she called me in some armour thyroid and I started on it that day.  Three days later, I was walking up my stairs again.  Don't get me wrong, it has been a long process, but it's hard to believe that it has been less than a year since I was honestly thinking that I'd have to give up my practice.  As of today, my TSH (thyroid lab) is exactly the same as it was when I started thyroid hormone - it didn't change at all.   Why?  Because labs don't mean everything.  The late, great, Dr. Robert Hess used to try to tell us that when we were residents, but then, we knew everything then, so why listen to the old man?  I wish he was still here so I could tell him that he was right after all. 

I can so distinctly remember a day about 6 months into this when Phil called me at work and asked if I wanted to go to a movie at 9:30 PM with him.  I immediately said sure and we hung up the phone.  Then I started to cry.  I cried because I couldn't believe that this conversation had happened.  I had been so sick that not only would I not have been able to say yes to that, but Phil would have never asked.  I just got hit with what this whole thing had done to my family.  He asked me out on a date and I said yes!  I would have had to really think about that in the past as far as - did I have enough time to take a nap before the date?  Would I be able to get up?  Would I be able to do anything the next day if I went? 

So, here I am a year later.  I am currently on 60mg of Armour thyroid.  I am also on an herbal adrenal supplement as adrenal fatigue and subclinical hypothyroidism often go hand in hand.  I take vitamin d, basic minerals, and progesterone at night.  I feel better now than I did even two years ago.  I have made some inroads with the weight loss that I now attribute to the thyroid dysfunction.  AND, I have started studying wellness and bioidentical hormone replacement.  I am very proud to say that I have received my board certification from the American Academy of Anti-Aging and Regenerative Medicine.  I attend conferences hosted by the bioidentical hormone society.  I am specializing in wellness, and I love it. 

I am still board certified by the American Board of Family Medicine and the American Board of Osteopathic Family Medicine.  These things are not mutually exclusive.  I'd love to do wellness exclusively, but in this region, it wouldn't pay the bills.  Much of what I do in wellness involves vitamins, supplements, and natural medicines that aren't covered by insurance.  Unfortunately, in WV, most people do not make enough money to pay for these things.  I try to incorporate as much as I can into my regular practice, then I hold a BHRT clinic for those people who want to only do wellness. 

As for my original doctor?  I still "see" him as much as any doctor sees another doctor.  He's convinced that I had post-concussion syndrome and that it resolved.  He thinks my TSH hasn't changed because armour thyroid isn't really medicine and doesn't change anything anyhow.  That's OK.  I was trained the same way and two years ago would have said the same thing.

Practicing medicine is 50% education, and 50% experience.  My experience has made me decide that my education was sorely lacking.  I'm happy with what I'm doing now, and I think a whole lot of people who I'm helping to feel better every day are glad that I got sick last year!

Dr. Mindy