Thursday, April 29, 2010

The doctor is... giving me more pills.

Doctor visit number two. And, shock of all shocks: my bloodwork revealed exactly nothing. The Lyme disease thing was an interesting notion. People in my life kept wanting me to be excited about it - "That's treatable! That would be great!" Well, it's somewhat treatable, and they kept missing that little issue where it would have been in addition to the fibro, not instead of. But the tests came back clean, even the fancy shmancy ones from Stoneybrook. So no answers there, and good riddance to the longest two weeks of worrying in my life. Oh, and I'm not pregnant.

What did show up, though, is that I'm markedly deficient in Vitamin D. I guess it's not so surprising - it's hard to get D through food, I don't go outside when it's hot, and during the winters here in NY the sun isn't even strong enough to make the skin do its cholecalciferol mojo dance. What aggravates me, though, is that back in August when my former doctor ran bloodwork (at the end of the summer, when all should be ripe and plump with D3 loveliness), it showed that I was already running a quart or three low. If I'd known, I would have spent the dark winter months supplementing, not just letting it continue to drop. But hey, why prevent something when we could just wait until I'm actually sick and then medicate? Garrrrr.

He wants me to increase my Topamax - everyone does. That's three doctors now. So I guess the jury's in. It's still a pretty low dose. I just hate increasing anything. He also wants to try me on Prednisone. When I was in his office, I was thinking, why hasn't anyone tried me on this before? When I got back to a computer I figured out why. Ah, yes, it's a corticosteriod.

I've been avoiding the steriods for a long time. They do their jobs well; unfortunately they come with a host of unpleasant side effects, and getting back off of them once you've been taking them for more than about a week becomes very tricky business. Prednisone, specifically, is an immunosuppressant. I hate the sound of that, I truly do. I am aware that my immune system works overtime, that that's part of my problem. But the concept of using chemicals to suppress my immune system makes me more than a little uncomfortable.

As far as I can gather, the drug sort of shuts down the adrenal cortex and then mimics the hormones it produces. These include cortisol, aldosterone, and various androgens. Cortisol (hydrocortisone) is the big player here. Cortisol increases blood sugar, plays a role in metabolism, and, well, suppresses the immune system. Normally it is released in response to stress; I'm thinking the purpose of the pills is to give a controlled dose, rather than the spikes I may be getting from my body's natural production. Actually, there's a good chance that I've been stuck in a sort of permanent (or at least continual) fight-or-flight state since my late teens, so who knows how much of it I'm pumping out - possibly way too much.

It's difficult to try to tease these things out for yourself. The processes of the body are quite complex, and it's been many, many years since I took my course in comparative anatomy of chordates. The bottom line is that I'm scared to deal with a new class of drug, particularly one that works by changing my body chemically so radically. There's also some vanity here: I don't want puffy cheeks. But there's another bottom line. It might help me be functional again - by a certain definition of functional, anyway. If it's between dealing with another pill and having to quit my job, well... anyone offering to pay my rent? So, job it is then.

Basically, I'm hoping for the best.

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