Reasons, excuses, and it’s not all in my head

A couple of weeks ago I went outside Kaiser to my former primary care doc to have my hormone levels tested. Since I had a hysterectomy almost 3 years ago, I expected this was a mere formality to know where I should start on hormone replacement therapy, assuming I decided to choose that option. Interestingly I had an appointment with Kaiser’s gynecology department while waiting for the results. She wanted to immediately put my on synthetic hormones, which I flatly refused. My sister, 4 aunts, 6 cousins on my mother’s side alone have had breast cancer, and all but 2 of my cousins died from it. My mother died of uterine cancer. With all the studies showing that synthetic HRT causes increased cancer in women, do you seriously think I want to go that route? No thank you. I actually had to sign a form saying I refused HRT treatment.

Not exactly refused it;  I merely refused their options for HRT. My outside Kaiser primary doc prescribes bioidentical HRT, which is apparently derived from sweet potatoes (good to know they are useful for something). Cost is 675% more than synthetic hormones (I am an accountant; I cannot help myself sometimes), but it seems safer than the alternatives. I do not think there is any evidence thus far that sweet potatoes cause higher rates of cancer.

So there is that. But chatting with my non-Kaiser doc yesterday (and this is the primary reason why I stay on his patient roster), the hormonal imbalance symptoms offer me some encouragement for the way overall health things are progressing with me. For once it’s possible it’s not all in my head. For once, I may have actual physical reasons for feeling fatigued, or weak, or not seeing more results obvious results from my health and wellness efforts.

My results showed my cortisol reading was 6, and normal range is something like 150 to 250 (not looking at the actual results, so memory is fuzzy on the very specific details). Symptoms of low cortisol are fatigue, brain fog, inflammation, and can cause low blood pressure and hypoglycemia … which could explain why I am still experience blood sugar crashes without any insulin or other diabetes-controlling drugs in my system.

To be perfectly honest, I’m not sure I had completely bought into the idea that hormones could be doing much to me other than impacting my fatigue levels. On everything else I have been fine the majority of the time – no hot flashes, no crying jags, no 24/7 PMS-like symptoms. However, as M says, why not try the safer bioidentical HRT and see if I can enjoy some better sleep, less overall fatigue, and see if my mind and my focus sharpen?

Why not indeed.

More interesting than all that, though, was my doc’s concerns about my current exercise level. He actually suggested that I may be working too hard at it, and perhaps a break from it until we get my hormone levels elevated would be in order.

We discussed this in some detail, because now that I am actually moving consistently, I am absolutely against the idea of stepping back and away and taking an extended break. To his credit my doc hears “working with a trainer twice a week” and imagines J standing around doing his best drill sergeant impressions while I am scurrying along muttering “no pain, no gain” like some sort of cult member to get through the sessions and collapsing on the floor as soon as time is called.

Well, sometimes the collapsing on the floor is accurate, but that’s just me and hey, it happens even when J is not standing there watching me do it. Probably more when I am on my own and do not give 2 shits who watches me lying there having brief but vivid fantasies of conking out for a power nap.

Doc was hugely relieved and reassured when I explained that I had started with J to learn to use weights safely and to train in such a way as to not hurt myself or others in the process. Our slow and steady consistency pattern – and me being a reforming “I really hate exercise” girl – convinced him that I am taking good care of myself and not overtaxing my system. He agreed I could and should continue, but stressed the “listen to your body” message as well. Except he doesn’t get my body whines for soda and chocolate and tells my head that it’s tired even before we arrive at the gym to get started much of the time. Sometimes the body and it’s message must be ignored to get things done.

But I do get what my village of experts mean, though, and I am heeding their advice and opinions. What is gratifying to me is that my fatigue at times is likely actually a real thing and has nothing to do with me being a lazy slacker when it comes to my exercise routines. That was an eye opener. I typically feel fine, better after training with J or a practice on my own, but there are plenty of instances where I simply cannot finish the 15 reps in the third set, and I would feel guilty about faltering and wonder if I am ever going to get over myself and just freaking do it.

While even a few months ago I would be secretly relieved to have a real reason for stopping whenever I want to stop, which could potentially be long before I need to stop. Now I view this as yet another wrinkle in training and practice, evaluating whether the fatigue is real and should be heeded or if I am having an off day and need to just keep pushing.

At the same time, I feel a bit vindicated in my inability to do more. I have been watching my diet, stripping away the gratuitous sugar and carbs, eating a lot more vegetables and fresh fruits instead, seeking more plant-based carbs whenever possible, yet making very little progress with the scale when I have been to see the docs and weighed in on their fancy-smancy medical scales. My body shape has changed, my little baby muscles starting to emerge, but I seem to be going up, down, all around with the same few pounds. I have wondered if I need to add some straight cardio to the mix, maybe more yoga every week, but honestly I have hardly any energy available for it in the evenings when I have time to pursue it.

I had decided awhile back that if my health is good enough I will make my peace with my body as it is right now and just go forth and continue learning as much as I possibly can absorb and make the best of the situation. Maybe Scott Abel’s books and writing are not as heavily loaded as I believe; maybe I am just more fogged-out than I realized. But I’ll keep trying, keep pushing, and do what I can until I find the right balance and solutions. I do know I am mostly relieved that it’s not just in my head, or that I have not truly broken something inside with the diabetes. Yes, there truly is no limit to the secret fears I harbor about my past self-destructive behaviors.

This doc did tell me not to add more to my schedule right now until we get my hormone levels elevated, so if I do cardio or yoga I have to forego my gym practice that day. There is an addictive component engaged right now that makes me very resistant to that idea, so I guess I will not be doing much yoga or cardio for at least a couple of weeks. Maybe; time will tell. I respect him enormously and understand his concerns, and I did assure him I will listen more closely to the signs and not discount them as me punting on commitments to myself. If I start feeling really fatigued I will take a day off or shorten my sessions. I felt that was a fair compromise. He has known me long enough, knows me well enough to understand how hard I have fought to make this incremental progress on the exercise habit and how demoralized I will be if prescribed to stop for a longer break.

For now and days like today, the zoomy sets I did this morning before a trip to San Francisco was the least stressful part of my day. I am glad I went to the gym beforehand, because I felt like it kept me calm and focused rather than climbing out of my skin and fighting the urge to slap the smarmy smile off my former boss’ face. Another client associate that attended the meeting knew nothing of our history, only that I had once worked for this firm, but afterward he remarked that former boss “tends to talk down to you.” I just smiled and said our history was complicated and I was delighted to be away from there. What was funny was the former president of the firm came up to me in the hallway and hugged me, asked about M and the kids, told me and showed me pictures of his own grandkids and new great grandbaby. The current president greeted me by name – she’s a very direct, no-bullshit sort of person and we got on famously during my tenure. It was kind of a slap to my former boss who treated me so poorly. Asshole.

I did have opportunity to see a lot of friends from that era, so that was fun. Lunch was at a frou-frou restaurant, and for those of us who do not appreciate fine dining, it was a completely lost on me.

Yep, still got some lingering anger. But oh well. So happy to be not still be toiling in those particular salt mines.

And really, really happy to be at home after a very long, hectic, busy day. Love my client – he’s a terrific, scary smart, interesting individual and just lots of fun to hang out with – but spending hours in the car with him and I came home with almost more work than I am sure I can complete on time. We will triage priorities on Saturday.

3 thoughts on “Reasons, excuses, and it’s not all in my head

  1. 6? Wow! Glad that the real doctor has a good solution. Just think how great exercising will be when you get the cortisol levels in range/stable! But until then – be smart and listen to your team!

    I’m surprised with your family history that Kaiser would push the synthetic option. But I’ve said before – Kaiser’s protocol works for 80% – but for those of us in the 20% – not only does it not work it is if they don’t care that it doesn’t work.

    So will you need to work with your old boss if they get the project?

    • Yep, you’re absolutely right. I’m not to the point where I feel like I’ve made a mistake with Kaiser – love my endocrinologist and my dietician and they are the backbone of my visits – but if an option to go back to Anthem exists at open enrollment I’m taking it.
      The old boss is going to have to tighten up his cost proposal if he wants the work, which is the primary reason I went with my client to this meeting. Assuming he’s successful, my interactions with him will be limited to the occasional schmooze-fest as the project progresses. Thankfully. He’s such a politician and such a jerk.

  2. I am also facing that question myself BUT also refuse to take the synthetic. Dad died of cancer, all three of his sister and two brother. Moms side I lost my grandfather, Uncle and 2 Aunts. And just last year my uncles wife was diagnosed with breast cancer after taking the synthetic. Thank God it was caught but no thank you there is no way in hell I am going there.

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