Tags
acceptance, blood tests, endocrine, hormones, lab work, lorazepam, lumpy gonads, PCOS, phlebotomist, reproductive endocrinology, v58.69, vasovagal syncope
Yesterday brought another slew of blood tests – just what I wanted for Boxing Day! Ye olde V58.69 – long-term use of medications – is the prescription code for “any and all tests I want to run.”
Blood tests by br3w, CC-NC (remixed).
My last comprehensive panels were about a year ago, just after the bipolar diagnosis. Last time I had endocrine levels done was just the start of the “lumpy gonads” shebang (thanks to the Amazing Sara Lomas for that phrase!)
This time I had a whopping 17 tests:
- CBC diff (complete blood count with differential)
- CMP (complete metabolic panel)
- T3 T4 TSH (thyroid levels)
- Lipid panel (cholesterol levels)
- HgAiC (blood glucose)
- Dhea sulfate (endocrines – same for the next 5)
- Prolactin
- Progesterone
- Estrogens
- FeSH/LH
- Testosterone: free, total
- Folate (folic acid)
- Lamotrigine levels (minding the dosage)
- LFTs (hepatic function)
- 25 OHViTD (total Vitamin D)
- VB12 (Vitamin B-12)
A metabolic/lipids panel has to be a fasting draw, and they can’t split up the “prescription” for tests. My body hates fasting draws; my blood sugar is low, I’m uncaffeinated and cranky, and vasovagal syncope – fainting – is practically guaranteed.
Miraculously, however, I stumbled onto the best phlebotomist ever! She did the cleanest, quickest, most painless draw I’ve had in years. It sounds kinda sad, but I’m more excited to find an awesome phlebotomist than I would be to find a great stylist. And boy, could I use a good stylist…
Anyway, the Amazing Phlebotomist drew 3 large and 3 small vials – the most I’ve ever had done at one time – and I didn’t pass out! I think part of it was the Amazing Phlebotomist, and part was having taken Ativan beforehand. I’m much less likely to have a panic attack when my blood serum levels of lorazepam are just peaking. 
Some of those 17 tests are standard ongoing monitoring, like verifying that my liver is still working alright and critical vitamin levels are OK. But the rest is taking a closer look at reproductive hormones.
Therein lies the Insidious Grain of Hope.
At a recent 4-month checkup on polycystic ovaries, there had been no improvement in the large cysts from hormonal birth control, so the GYN just had me go off it entirely. My PNP was puzzled about that – the pill had substantially improved cramps and acne (clearly suggesting hyperandrogenism associated with PCOS) so it would have made sense to try a different pill that might work better. Personally, I think the GYN doesn’t want to be bothered to dig any deeper. She probably thinks I’m just crazy.
The PNP, however, seems pretty convinced that PCOS may be one of the root issues. I can’t help but agree. What I can’t guess is whether it’s PCOS and bipolar, or just PCOS. After 7 months trying to get that question resolved, I’d guess “both” but who knows? The hormone levels from these tests will likely get me referred to a reproductive endocrinologist.
In the meantime, this is-it-isn’t-it thing is driving me up the wall. How can I accept and deal with these problems if even the doctor hasn’t fully bought into the diagnosis? At the same time, I just can’t ignore the possibility that it may be entirely hormonal (with a little neuroticism.) Although I’ve struggled with acceptance all along and this is just making it harder, it seems we’re keeping that insidious little grain of hope alive for awhile longer.
Awesome phlebotomists are hard to come by! Glad you didn’t faint. That sucks about your GYN not trying you on a different pill though. Seems sort of lazy on the doc.’s part to not try an alternative. Hope everything turns out okay.
It went better than I was anticipating, for sure. I’m not thrilled with the doc myself, but not keen on finding another one. In any case, the specialist seems a more promising direction.
Well, that’s good anyway. It is difficult to try and find another doctor and hope they’re better than the one you left.
Much harder than people make it sound – it took me 3 full months to find a new psychiatrist last time I had to switch docs.
I can believe it!
That’s the down-side of medicine being so specialized these days; and G.P.s often (apparently) don’t keep up with and oversee all the inter-related aspects of a patient’s care.
I sure do hope they all settle in on an accurate diagnosis and treatment plan for you very soon!
I don’t even have a GP – I get most of what I need from my psychiatrist. I can’t imagine a GP being ringleader to my psychiatric nurse, therapist, and gynecologist, not to mention whatever else comes into play! That’s definitely more than they get paid for with the carrier-negotiated rates.
I am learning SO much from reading your blog, DeeDee. Thank you for all the research you share with your cyber-friends!
Happy I can offer something of value!
Regarding how much various health care professionals get paid, I’ve only just recently come to see what this looks like in action because I switched insurance, and as a result I’ve seen statements with exactly what the provider charged and what the insurer allowed. A $65 therapy appointment only pays out $31, and the $300 medication costs only $94. My GYN charges something like $75 but gets paid around $42. The accompanying ultrasound is charged at $170 but paid at $125. I suspect a GP would get an even lower rate than the GYN, since s/he would not be considered a “specialist” which usually incurs a higher payment.
It’s crazy. No wonder consumers can’t wrap their heads around US health care!
What ever happened to the wedge resection? Used to be the standard laparoscopic response to PCOS. Worked, too. No side effects, two day recovery, bye-bye facial hair. Gone out of style for some reason I’ve missed since I went into seclusion?
Never even heard of it. No one with the say-so to make a Dx is convinced I’ve got PCOS despite all the symptoms adding up. Seems like they try to avoid surgical procedures if possible – Metformin is a common first treatment to address metabolic stuff.
I’ve been getting laser hair removal for some time, but what I’d like to reverse is the thinning hair. All the worse since mine’s so fine.
Obviously, I don’t know you or what you’ve been experiencing lately, but from your ‘Making of a Madwoman” post, it seems like the bipolar diagnosis is probably right. There’s always a small amount of “it could be something else” from doctors, I’ve learned, simply because it’s pretty difficult to make a 100% positive psychiatric diagnosis.
When I was first diagnosed bipolar, I was just starting training for the Peace Corps, and later, when I was feeling more stable again, I was convinced that my manic episode was triggered by a mixture of cold meds, immunizations and malaria medicine. I stopped treatment for a long time, and did pretty well. I had another manic episode a few years later, but convinced myself that that one was situational too, as I had been under a lot of stress and am prone to catastrophic thinking and am not afraid to ‘jump of the cliff.’ I stopped lithium before trying to get pregnant, and after I had kids, I was stable and off meds again. A few years ago, I hit the lows big time. I got help from a great D.O. who ran all kinds of tests and eventually prescribed Lamictal. I also take an anti-anxiety med. Still, after about a year of being on Lamictal, I was not convinced that the bipolar diagnosis was accurate. I attributed my extreme low to situational occurrence too–I normally was not depressed and this was triggered by something very specific (in my mind.)
Finally, my therapist said, “Are you having troubles with the meds?” I wasn’t. I just didn’t want to take them because I thought they were unnecessary. “Have you had any major episodes of mania or depression since you’ve been on the meds?” I hadn’t. “Maybe they’re working” she said. Believe it or not, I hadn’t even thought of it that way.
A couple of weeks later, I saw my psychiatrist for a check-up and told him I still wasn’t completely convinced that there wasn’t something else up with me. He asked the same questions that my therapist did. Then, he said something that hit home: “Look, you are bipolar. You’ve had 2 major manic episodes that landed you in the hospital for 2 weeks each. You then had a major depressive episode that you claim you never want to have happen again. You aren’t experiencing side-effects and your mood is relatively stable. Why would you want to chance it again?” They were right. I didn’t want to accept that I was bipolar, but I definitely didn’t want to experience what I had been through again, so I figured that as long as the meds continued to work, I had to just accept it. This happened about 3 years ago and I honestly have just recently truly bought it. Amazingly, I feel OK about it. Looking back, I see that, even though some of it isn’t very pretty, it’s ME.
This is a long comment, but I wanted to let you know that I understand the need for it to be ‘something else’ and that the questions might last a long time. I was diagnosed 25 years ago! (It’s been a reaaallly long process.)
I guess what I want to say is that we all have that hope that’s it’s something else, But if it’s not, it’s OK. It’s just good to feel good.
Best to you!
I just want at least this particular thing resolved because it’s more or less the last potential explanation other than bipolar. It’s only been a year since diagnosis and I don’t expect to have it all worked out in my head, but eliminating the alternate explanations would really help convince my rational mind a little quicker.
There’s enough comorbidity between bipolar and PCOS that I’ve seen suggestion in research articles that there might be a causal link.
Hope they decide what diagnosis is right, this indecision must be disturbing.
Taking another kind of pill sounds like a good idea but I had the same problem with my GYN, maybe there is a reason for that? The pill I was on worked with cramps and facial hair and didn’t worked for other problems so my doctor told me to stop taking any pill, maybe there is some justification for leaving you without it too, I don’t know, you could also be right and she just thinks you are crazy, it happens a lot too.
Good thing you didn’t faint, it sucks, I used to faint when having blood tests but they always take around six vials after hours without food, some tests are to take blood two times in the same day, I could use an Amazing Phlebotomist too and thanks for teaching about the word Phlebotomist, didn’t knew that one.
Well, I definitely had very bad mood swings from a triphasic pill in the past, so I think the GYN doesn’t want to risk that. But in the past, I wasn’t on bipolar meds, so it could be totally different now, for all I know.
And there are a bunch of other options besides the ones I’ve tried – since it’s not for actual birth control, I see no reason to try some different options until I find something that works well. However, going to a reproductive endocrinologist might help pinpoint what would work best by figuring out what’s not working as expected.
I have many fainting stories when I’ve had blood tests done! I’m the same as you. I hate them with a passion. But if I’m allowed to lay down and I get a good doctor to take the blood then I’m OK.
Wishing you well and well done for looking after your health and checking these things out.
Keep us updated x
If I can completely lay flat, and if they draw from my left arm instead of my right (which has a “wiggly” vein that is close to my tendon) then the odds are a lot better that I won’t faint. But they can’t always do that.
And I do think the lorazepam helped. I did lots of DBT skill practice, telling myself that I had done this a lot of times before and it is always fine, even if I pass out. Etc, etc, etc.
It’s so hard to find someone who can draw blood without making you feel like they just butchered you. My veins float the second they get a needle in, which always makes me dread going for blood work. Anyone that can do it right and do it fast is a gem in my book too.
Hope you will get a proper diagnosis soon and start feeling better. =)
I knew this girl was good when she spent about a minute pushing my veins around to see where to poke. The right arm was “wiggly” but the left was not – so a much better choice! She was also very smooth on swapping out the tubes, and though I could hear it, I couldn’t really feel it.
I definitely feel better in many respects than before starting treatment for bipolar, so you know, it’s probably an accurate diagnosis. There are several layers to the mood swings that indicate multiple causalities. Knowing how hormones are interfering and exacerbating problems would help a lot, so I’m willing to keep hacking away at it…