Sheesh... can't a guy get a break?
So let's take all of this in increasing order of nervousness. That means we'll start with the optometrist. I haven't had an eye check up in a couple years. I just forgot to schedule it and my optometrist's office never called to remind me. Thankfuly, I don't feel that I have had much change in my vision. The bifocals are working fine and I'm really hoping that the eye exam will show good health as I should be replacing some of my glasses.
Yeah... glasses. I have several pair. I have my every day pair. Big thick black plastic frames with bifocal lenses. Those are my every day lenses and I honestly love the frames (I've talked about them before, Oakley Currency frames). I have my reading glasses that I use when I"m at the computer and as a backup pair when I go traveling. That pair is single vision with my 'close up' prescription. And then I have my sunglasses that I primarily use for driving, but are also used on trips. Those are single vision as well, but are distance only.
The sunglasses are toast. The lenses both have major scratches including one on the left lens right over my primary field of vision. The frames are bent all to hell since I take them to work with me and we are no longer allowed to use hard cases. So at the very least, I'll need new sunglasses. If all goes well, I'll get one of those frames that bend a lot but flick right back into shape. That way when I wear them in my pocket in a soft case for work, I won't be making them fit all askew on my nose.
The readers are fine. Seriously, I rarely take them out so they go from the hard case on my desk, to my face, and back into the hard case. The lens coating is getting thin and they get dirty fairly quickly, but I keep a microfiber cleaning cloth handy and can polish them back up in no time at all. So long as that part of the prescription didn't change, I'll just keep them as is without a replacement.
The bifocals should probably be changed. They have a few nicks and scratches and are getting more and more difficult to clean. But since I love the frames, I'm hoping that they can simply make me replacement lenses. Oh, I'll look at the other frames, but I honestly can't imagine finding a better pair.
That appointment is in one month, so in five weeks I'll probably be out about $1000 dollars in eye glasses. Yeah, my vision insurance is rather shitty.
So if the optometrist visit isn't all that concerning, then next up is the dentist. I had my dental cleaning and it went fine. But as always, the dentist came in and poked around and found that one cavity that we've been talking about filling. Sadly, it's too late for that as the cavity is both bigger and wider than before. So that tooth is going to be ground down to a stump and covered up with a crown. My second crown. The first crown I got last year wasn't bad and honestly I'm hard pressed to point out which tooth is the fake one by feel alone.
So unless something is different this time, it should be an in and out procedure and I'll have no problems or pain. But the dentist did note that my mouth is awfully dry. It's not a big surprise as both my soda drinking and my smoking will contribute ti dry mouth. It's never bothered me much, but he said that it could be a contributing factor to all the cavities I've been having. He highly recommended I start using a biotene daily mouth rinse and some lozenges through the day that will help keep my mouth nice and moist. On top of that, my hygienist suggested I use a daily mouth rinse with fluoride and that would help me as well.
Now I've used biotene before and frankly I'd rather have my teeth rot than use that shit. It tastes awful and the flavor lingers. Ick. So instead of that particular brand, I'm using Act Dry Mouth twice a day. It doesn't taste great or anything, but it's far more palatable than the biotene and it also has the fluoride.
The next more concerning thing is the doctor's visit. It seems every time I see him, I come with bad news. Either a worsening condition or a new medical problem. Last time it was the diabetes, but he prescribed glimiperide and that has really turned this disease around. My A1C was 7.1 (not great, but way better than before), and after one more 3 month checkup we'll be moving to either 6 month or 1 year checkups.
But then I add another problem onto my medical list. This time it's my shoulder. I've had problems with my left shoulder for a long while. Say maybe 10 years? It's just weaker than my right and will hurt if pushed past it's natural point of resistance. Well it's gotten a lot worse since my fall at work last year. It's now to the point that it hurts when I put on my clothes (shirts of course, but also my pants, socks, and underwear), and I'll often stop as the pain skyrockets when I'm putting on my coat. I'm also having trouble washing my back as it just hurts to put my arm behind me.
It's even affecting the way that I stand. When I'm bored my natural standing position is with my arms crossed over my chest. Now that position looks confrontational so I force myself to either clash my hands in front of me or preferably, behind me. Kind of a military 'at rest' position. But I can no longer put my left arm behind me without it hurting. Hell... I can't even sleep on my left side without it waking me up in pain.
So I told the doc about that and he examined me and had me demonstrate the new range of motion I have. He quickly came to the conclusion that I assumed it would be... a rotator cuff injury. Those are bastards as it can be one of several of many different actual injuries. Cartilage, tendons, muscle, and even bone can be involved. I've educated myself on the process and wasn't surprised that the doc wanted me to start with some passive range of motion exercises. These are methods of strengthening the muscles in the shoulder area and can sometimes fix a problem like mine. But more often than not, it won't happen all on my own. The doc said that if I wasn't making progress by about a month, that I should call him and he'll get me a referral to physical therapy.
There, a physical therapist will guide me through similar exercises but also see where progress should be made and guide me into how far to push myself. But at the end of the day, it's just a guided form of exercise like what I'm already doing. But if the doc wants it, I'll go along. Not because I think it will help, but because I'll give everything a chance. You see, the next step would be surgery. A shoulder surgery can be minor or major and can involve as little as four weeks recovery and as much as 12 weeks recovering.
I can't afford to be away from work for that long. Sure, I have some sick time (but not a lot as most of it is used up by migraines), and I even have long term disability insurance that would pay most of my wage while I recover from a surgery like that. Most of my wage. I use almost all of my pay, so any reduction is bad news. And if I have to sit around the house without using my left arm for months, I think I'll go stir crazy. The community at D&X would probably love it, but I'll just hate it.
Oh, and I also brought up my 'cold'. Last year I had a 'cold' that lasted from December until I saw the doc in March. His fix was some antibiotics and some singulair. Yeah, singulair is a medicine designed for asthma, but it also helps with seasonal allergies. I got better so I stopped taking the singulair and was fine.... until January of this year. The 'cold' came back more minor, but still there and still annoying. Congestion in my chest, nose, and sinuses. Coughing and sneezing. Dry eyes.
Dry eyes. When I realized that was something I was experiencing, I realized that the antibiotic didn't clear me up last year... it was probably the singulair. So I told the doc about what I was experiencing and he put me back on singular as it worked last year. And it worked this year too... I feel a LOT better now that I can breathe through my nose and I've only been on it for a little less than a week. Going forward I'll just stay on it as we don't know what the actual allergy is and it really doesn't hurt anything if I'm on it year round. Next year, hopefully, I won't have any problem in December or January.
So that was the doc. Lsst up and most unnerving was the neurologist. This is the referral my doc got me in December when I complained that my migraines were getting worse. As the apoinent was three months away I went ahead and got a migraine diary so I could keep better track. I figured at the very least, I could use it to guage a 'before and after' situation. The diary has helped a lot more than that though. It's told me that I've had 18 major headaches in the past three months. 7 of those were actual migraines while the others were either standard head aches or tension headaches. Now 7 over 6 months doesn't sound all that bad, but that's seven times I couldn't work or even be in a family/social situation. And while the average headache lasts about 4 hours for me, those 7 migraines lasted an average of 21 hours. No, I didn't type that wrong.
Twenty One Hours!
It's a major problem. For one, I only get 4 hours of sick time per pay period. About 1 day a month. But if I'm having 7 migraines every three months, I'm going to run out of sick time. I'm actually 'lucky' that two of the migraines in the past 3 months have been while I was at home.
So I got my appointment with the neurologist. I pre wrote up a bunch of answers to what I figured would be common questions and he liked that so much he had it scanned and added to my chart. And even though I knew most of the steps to prevent and treat migraines, he went over them with me. Three are four main lines of medicines that can help with preventing migraines.
Blood pressure medicine
Andi-depressent medicine
Anti-seizure medicine.
Oddball meds.
I already have propranolol for a migraine preventative and it's considered the best for reducing migraines. The second best one is cozar and that's the medicine I actually take for high blood pressure. Since the propranalol worked to reduce the migraines when I started it, the neurologist decided that there's no reason to change it.
For the anti-depressant medications, I'm already on wellbutrin. Like the BP meds, since what I'm on is working for it's intended purpose, he doesn't want to stop it and try something else. There's no need to help the migraines if I fall into depression again.
Anti-seizure medicine. There's quite a few out there, but the three that seem to work for migraine sufferers are Topamax, Depakote, and Neurontin. They all have side effects and can work over a wide variety of doses, so it's a long process to 'try' any of them. Topamax might work at 25mg a day... it might not work until 200mg a day. The neurologist suggested we start with that one and immediately start tapering up to a 100mg daily dose and I'm in full agreement. We chose Topamax because one of it's major side effects is weight loss. With diabetes that could actually be a good thing. The other side effects I have to watch out for are a numb/tingling sensation at my finger and toe tips. It's not actual damage being done and it will go away if I taper back off the medication. And finally the side effect that has me most worried is a difficulty recalling specific names. That's peoples names as well as drug names. I already have a problem with this and it's not known if it will make my current problem worse, or I just simply won't notice the side effect as I'm already experiencing it.
I could tell the neurologist is experienced and in this for the long haul. This isn't just a system of prescribe the one med and wait a year to see if it works. I already have a follow up appointment in July and we'll decide if it's working well enough at that point. If it's not, we can go to a higher dose, try another anti-seizure medication, or move on to the 'oddball' meds. We're very close in thinking because I've been hesitant about every trying depakote or neurontin as they both have the side effect of weight gain.
He mentioned two of the next meds we might try. The first is the one that bothers me, but it makes sense in how it works. Botox. Yup, that rich lady face lift medication. The way it works is that I'd be injected with botox along my forehead, shoulders, and up my neck. It's going to numb a whole lot of nerves, but it's thought that those nerves are involved with making headaches and migraines. If it works, I'd have to get it done very 12 weeks or so. It's an expensive treatment so most insurance companies have strict guidelines on how they approve people for it, but I have so many headaches and migraines a month that the neurologist already thinks I'd easily qualify. The only hurdle is to at least try one anti-seizure medication first. He mentioned another med, but I've forgotten the name. It's very VERY new though and he was part of the clinical trials. It's technically not even on the market yet, but it's supposed to be there by July.
He also prescribed me a medication to tackle a migraine once it starts. I've tried the primary medication in this group before called Immitrex. But when I took it, it didn't help the migraine at all and it gave me incredibly severe nausea. So we're trying a second generation form of the medicine and hoping that it does better. Both at helping an ongoing migraine and at not making me nauseous.
So... I'm taking another big swing with my migraines. I should get the medication next week and then it's off to the races. I'll be on 25mg of Topamax for 2 weeks, then up it by 25mg additional every 2 weeks until I get to 100mg a day.
No comments:
Post a Comment