2nd visit with the endo

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2nd visit with the endo

It’s a tad tricky figuring out an image that actually represents endocrinology. While all doctors and nurses work on a computer in the exam room, this picture could easily apply to an admin assistant also.

In case anyone is wondering, Dr. Yan is a board-certified endocrinologist, not an admin assistant! 😉

While I’ve tried to make this blog as chronological as possible, when discussing some things, like reversing adrenal insufficiency and weaning prednisone, and the post about how I decided to proceed with weaning T3-only meds for my thyroid resistance, it only made sense to tell the entire story from beginning to end regarding each subject since I knew the outcome.

Much of what happened during my second visit with Dr. Yan has already been covered elsewhere in this blog.

But those reports are primarily the facts and I wanted to share the post I made at the time, which has much more of the emotion I was experiencing at the time. And hers as well!

I posted this to the ELAB group on November 29, 2019 (3 days shy of the 4-month anniversary of my start date).

I have the best endo in the world. She has a perspective that makes me feel better. Also, I am utterly unaccustomed to a doctor who works *with* me.

So I had bloodwork on Monday, got the results on Tuesday, saw the endo on Wednesday. I was not happy with my bloodwork.

My A1c was 6.7%, which disappointed me. My Libre says my 90-day average was low enough that I was hoping for a value under 6. Way back when, a group of diabetics I knew who measured every morsel we put in our mouths and titrated insulin closely with carb and protein ratios called being under 6 being in the 5% club; I wanted to be back there.

My triglycerides were 193, still out-of-range, which is under 175. This is an indirect measure of insulin resistance, and my little fiasco with the dark chocolate indicated I still had plenty of IR, so I don’t know why I was disappointed. But there you have it – I was, though my values have been closer to 250 the past few years.

So this tiny, little Asian lady comes walking into the exam room and is all excited, “Your A1c went from 8.3 to 6.7 with NO insulin! And only 1000 mg metformin, a rather low dose. That is amazing!”

Well, that reframed my disappointment pretty well! Her perspective as a doctor with mostly patients who aren’t trying to improve things, including me most of the time I’ve known her, is very different from mine. The same A1c that disappointed me made her day!

She also found a 20+ pound weight loss in 4 months amazing, which is only about half of what the fast losers here do, and I remembered that I’d have considered that pretty good a few years back myself.

My BP came in at 136/78, not perfect by any means, but given it was always much higher than that on lasix, carvedilol and lisinopril, she was amazed at that too.

She asked for more detail on what I ate and I told her I’m eating 4 times a week, dinner on Thu, Fri, Sat and Sun. Her eyes got wide.

She asked if I was having any bowel problems, and I said I get a lot of fiber and indicated with my hands how big my salad is and her eyes got wider. She was pretty much bouncing in her seat at this point.

We discussed my adrenal insufficiency. I had gone from 7 mg -> 5 mg prednisone, then gone in for a morning cortisol draw, and all was well then, so had continued weaning and was off entirely for a few weeks when I was tested Mon, and all was well again.

I said I’m entirely off prednisone and don’t expect I’ll ever need it again, but might need hydrocortisone for stress-dosing. And she said, we can test that right now, we’ll give you a shot (like the ACTH-stim) and you can get a draw downstairs in an hour and see if your adrenals can handle stress themselves.

Frankly, about a half hour after the shot, I realized either I had major amounts of cortisol or if not, I was full of adrenaline; I felt like I’d had 3 pots of coffee and my heart was racing. That test came back with an incredibly high cortisol level, so apparently I just have perfectly functional adrenals after over a decade of not.

Back to the appointment though. We discussed thyroid also. There is nothing wrong with my thyroid gland, I just have a propensity to make rT3 instead of T3. Most of this conversion occurs in the liver, also the organ that is primarily involved in T2 diabetes, so no real surprise there.

I was still on 37.5 mcg of liothyronine at my appointment, intended to suppress T4 production to clear rT3. So my previous bloodwork, a couple months ago, showed both FT3 and rT3 below range, which confused me. My temps are fine, I have more energy than ever, I feel very well, so didn’t understand how my FT3 could be so low. I’ve discussed with a few thyroid folks and I still don’t understand, frankly.

She agreed with me that attempting to wean was a good idea since I’m asymptomatic, scheduled me some labs for 1 month out to see how I’m doing. So as of Thanksgiving, I’m on 25 mcg, cut my dose by 1/3rd, and will continue that for a month before we check. If all goes well, I’ll be off that entirely by my next appointment in Feb.

She got very excited when scheduling labs at the computer. I asked for a fasting insulin and she said, yes, and let’s check c-peptide too! I think we have both gone beyond strictly health care into the realm of curiosity about what the heck is happening inside me. She asked if there was anything else I wanted to test; she’ll apparently write all the labs I could ever want.

She just had so much enthusiasm for my improvements, has been so willing to help me with all the labs while weaning, and always discusses things with me in detail. She’s not just the best endo I’ve ever had, but the best doctor.

So… while I am ridiculously disappointed that I haven’t cured my diabetes quite yet after over 3 decades of being ill, overall, my endocrine health is where it was 20 years ago. Not perfect by any means, but way more improvement than I ever expected to accomplish.

Shortly after my clean bill of health from the endo, I had my first illness on keto.

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