Pill Poppin'

Every morning (plus an injection)

It all started with an antidepressant. For more than a decade, I've taken Zoloft every morning. There have been periods when I've tried going off Zoloft or have tried other antidepressants or have supplemented with others, but Zoloft is the one that I've come to accept will never go away.

Then I was diagnosed with diabetes, which put me at the same risk for a heart attack as someone who has already had one. So I started taking a tiny pill for high blood pressure another one for cholesterol, neither of which were too high, but we were taking precautions. And a baby Aspirin.

And three years later, my diabetes kind of went crazy, so I went on Metformin.

And it progressed to this:

Morning and bedtime

Or, another way of looking at it:

Prescriptions on the left, non-prescription on the right.

Yah, I feel old.

Here's what you're looking at:

Prescription

• Metformin for blood sugar
• HCTZ for blood pressure
• Zoloft for depression
• Simvastatin for cholesterol
• Tecta for reflux
• Victoza (an injection) for blood sugar

Non-prescription

• Vitamin D for depression
• Vitamin B12 for depression (I think. Or it may be for memory loss.)
• Ibuprofen for bursitis
• Claritin for allergic rhinitis (to reduce the number of sinus infections I get)
• ASA to prevent heart attack

It's gotten to the point that filling my pill boxes takes about ten full minutes once a week. Actually taking the morning pills has to be done in two handfuls.

It sucks, but it's part and parcel of having a chronic illness. The alternative is even less appealing.

Unravelling the Mysteries

A photo of me and my siblings, taken sometime before 1980.
Top: Christine
Middle: Wynn Anne, Pat
Bottom: Andrew, Stewart, Douglas, Harvey

That picture was taken when we were all young and healthy, while our parents were still (relatively) healthy. And it was taken before much usable research was done into the mysteries of the human genome.

Since then, the world of genetics has blossomed, and we've learned more than we ever dreamed. Cystic fibrosis, from which two of nieces suffer, was one of the first diseases whose genetic marker was pinpointed by researchers. It is now one of the first to be targetted for gene therapy!

The New Doctor

We moved back to Canada from Colorado on July 1, 2010. I've been looking for a regular family doctor ever since then. I had no idea how difficult it would be.

For a while, I went back to my next-to-last doctor in Ottawa, but was increasingly dissatisfied there. Then I got lazy and just went to walk-in clinics. And then my blood sugar went sky high because my diabetes was unmedicated and completely out of control.

At that point, my search for a family doctor became a little desperate.

Then, one day, a friend bumped into her friend, who happens to be a family doctor here in Ottawa. That friend mentioned that her practice had just taken on two more doctors and was accepting patients. Happy dance! Woop! Woop!

[Side note: I had registered with the Ontario Ministry of Health's database to help people find new doctors. They somehow were unaware that this practice was accepting patients. Sad.]

Within minutes, I called the office and made an appointment to meet one of the new doctors. Today was the big day.

I liked the practice right away: the front-desk staff were friendly, but businesslike. They didn't keep me waiting for more than 15 minutes (during which time I filled in paperwork).

The doctor herself was both friendly and professional. She was also frank about a few things that she thought might be issues for me:


1. They prefer that their patients not go to the many, many walk-in clinics in the city. This is because when they take me on as a patient, the Ontario Ministry of Health pays the practice a flat stipend for routine medical appointments. If I go to a walk-in, the charge for that visit is deducted from my doctor's stipend.

This is my preferred approach anyway - I would rather see my regular doctor than a stranger! (I haven't had great luck with walk-in-clinic doctors and I loath the amount of time wasted waiting.) 

2. In order to support this approach, they have a system called "Better Access." Although some appointments can be booked in advance, most, including routine follow-ups, are only booked 1-2 days ahead. This allows for more impromptu visits.

This also suits me fine. It can be difficult to plan my schedule more than a week ahead anyway. On the other hand, she does consider stabilizing my diabetes a high priority and allowed me to break the last-minute-booking rule and make a follow-up appointment in September.

3. They also have long hours and their own after-hours on-call doctor. This helps cut down on the need to go to a walk-in or emergency.

Sure wish I'd had access to this care when I spent hours in emergency for chest/neck pain. They might have made the same recommendation (my symptoms were ambiguous), but it still would have been better to have some follow-up.

4. She has only prescribed Victoza for patients who have received their initial prescription from an endocrinologist, so she is not an expert at all. 

Neither was the walk-in doctor who prescribed a medication on top of the Victoza that threw me into hypoglycemia. It's not ideal, but she's aware of this gap in her experience. And, unlike with the walk-in doc, I  can call the office immediately, rather than waiting a week.


5. They are pretty conservative about ordering tests and lab work.

But she does like to establish some baselines, so she ordered some fasting blood tests right off the bat.

6. She is not accepting any new patients.

But, she will take anyone from my family, including Steve when he retires from the military in two years. She will also take Brian.

All in all, I am one very happy woman.

Bonus: My new doctor's office is about a five-minute drive from home and about 20 minutes from work, so not bad.  

There's just one thing that I can't figure out.

Peter Falk, scratching his head.

Remember Peter Falk’s squinty-eyed Lieutenant Columbo? 

We all waited for that moment when he would walk dejectedly away from the murderer (who would be smirking, thinking he had literally gotten away with murder), then pause, scratch his head, turn back to the guilty SOB and apologetically say something like, “There’s just one thing that I can’t figure out.”

Within seconds the tightly knitted veil of deceit would unravel and the killer would have given away the entire case.

Last week, as I left my doctor’s office, I felt like Columbo – but about three minutes slower on the draw. 

By the time I thought of the questions I wanted to ask, the doctor was on to her next patient and I was at the pharmacy dropping off new prescriptions for drugs unrelated to my questions.

A few minutes earlier, the doctor had blithely noted that my ECG results had been normal. Then we spent several minutes discussing my diabetes meds (and even my pearls!), without returning to the ECG and the reasons for ordering the test (the bizarre morning pain that scared the crap out of me).

So many questions ran through my mind:

• Does that mean it’s not angina?
• What should I do if it happens again?
• Could it have been a stroke-type thing? Or a transient ischemic attack?

All of which remain unanswered, except by the internet.

Does that mean it’s not angina?

No. Angina is not usually detected on an ECG unless it actually takes place while the electrodes are stuck to your chest. This works well with normal, activity-related angina, but not with the kind that occurs while you are resting, as I was. ECG is great for showing that there is damaged heart tissue, as is the case with a heart attack.

What should I do if it happens again?

If symptoms do not abate after 5 minutes of sitting up and resting, call 911. In my case, even if the symptoms do ease (with or without coughing), I will get myself to a clinic and ask my questions.

Could it have been a stroke? Or a transient ischemic attack?

Actually, the internet cannot answer this one. I will have to talk to an actual doctor about it.

Which brings me to the best news I’ve had in AGES: I finally have a doctor. Well, sort of. I have a meet-and-greet appointment with a doctor in August. She is in a group practice near our home and is about three years out of school. She probably looks like a teenager. 

No Regrets

Even with all this laundry, I don't regret being a
stay-at-home mother for more than a decade.

This is actually the fourth in a serendipitous series as I contemplate my health and longevity.

Part I: A Heart Attack Waiting to Happen
Part II: And now what?
Part III: Wynn Anne Versus the Volcano

---

As well as looking ahead and thinking about how I want to spend the next 15 or 30 years, I've looked back at how I've passed my life.

Despite the title of this post, I do have some regrets, of course, including some pretty big ones (like buying or selling a house at the wrong time). Most of my real regrets are about things I've said or done that have hurt other people, sometimes intentionally. If I could time-travel, I would go back and say, "I'm so, so sorry. I was not thinking."

Mostly, though, I am grateful.

[Note: As I wrote these, I felt a distinct sense of apology, like I somehow needed to reassure every one of you that your choices - if you even had them to make - are okay. I'm trying to express gratitude, not to gloat or judge. Please accept these thoughts in that vein.]

I'm glad I married young.

It's definitely not the right choice for everyone, and I was extremely fortunate to marry Stephen specifically. But it wasn't just luck either. With a few exceptions, the boys I dated in high school and university were all really good men - good "husband material." Obviously, there were very good reasons why those relationships crashed and burned, but my point is that I was making relationship choices that set me up for success.

When I fell in love with Steve, we both knew we wanted marriage and children as priorities in our lives. This goes back to my discussion of shared values as being central to our marriage. If my priority, for example, had been to travel the world, then marrying young and (especially) having children young might not have been compatible with that desire.

I'm glad I had children young.

When we finally decided to "start trying," I had difficulty conceiving Katie, our eldest. Being a tad on the melodramatic side, I rode that emotional rollercoaster at full blast. The thought of not having children was heartbreaking. I think that if I had postponed parenthood and then faced naturally diminishing fertility, I would have regretted waiting.

As it is, even if I live less than the 74 years that Statistics Canada estimates I may expect, I will live to see my children grown, probably even know my grandchildren (not just meet them). I like that very much.

I'm glad we had "lots" of children.

It humours us to think that four children is considered a large family, but it is nowadays. We were going to stop at three, not because we didn't want more children but because I was terrified of going through childbirth again. Also, I needed to be on antidepressants and was not willing to be pregnant or breastfeed while taking them.

Watching our children together is a real pleasure. I love how they each bring out different aspects of the other, have conversations with one that they wouldn't with another. I know them better by witnessing that alchemy.

I also enjoy how I am different with each of them. There are versions of Wynn Anne that I might never have known otherwise.

I'm glad I stayed home with my kids for as long as I did.

I relish the memories of curling around Emily during naptime, or letting the kids climb on me while I weed the lawn, of play groups with a roomful of moms and toddlers. Those long, unstructured hours. They are a luxury, and I am so grateful to have had them.

I'm glad I also had a career.

When I finally did start working outside the home, boy, was I ready for it! And I loved it. I thrived - and still do - on the energy level of the workplace, on the mental and social stimulation. I like the financial benefits, too.

---

Despite the old chestnut, I'm willing to bet there actually are people who, on their deathbeds, thought, "I really wish I'd put more into my career." Obviously, I'm not one of them.

Wynn Anne Versus the Volcano

Based on Joe Versus the Volcano,
a very under-rated movie.

This is a continuation from my previous post, where I started to write about my father, who died almost exactly a year after he retired.

My dad's nickname at work was OT Simpson. The OT stood for "overtime" because he was always looking for extra pay. With seven children to feed, clothe, shelter, and send to university, that's probably no surprise.

He worked in construction, from dawn to dusk. He was gone before I woke in the morning, back in time for a late dinner. He often took a nap in the evening.

When he finally retired, I think we all felt he was overdue for a rest.

But he'd had triple-bypass surgery about four eight years earlier and was not in good health. He'd tried to quit smoking but we all knew he was sneaking cigarettes. His blood sugar was bad (though he was not diagnosed with diabetes).

And then, one night at dinner after complaining of an upset stomach all day, he collapsed. He never regained consciousness. He was 66 years old.

In Joe Versus the Volcano, the main character is a workaday chap slogging away in a mind-numbingly dead-end, pointless job. One day, he learns that the annoying cough he has developed is a terminal illness and he has mere weeks to live.

In classic Hollywood style, he drops everything and takes off to have an adventure. (I almost told you how the story ends, but you'll have to see the movie for that!)

As I pondered my own health and mortality, I wondered: if my dad had known at 50 that he only had 16 years left, would he have made any different choices? Would he, like Joe, have dropped everything and taken off on an adventure?

One of the questions Steve and I have tossed around is whether or not I will retire when he does two years from now. Because I took many years off to have babies (years that I do not for one moment regret), I've thought about tacking some of those years on to this end of my career.

I enjoy my job and the people I work with. I look forward to going to work (though I often wish it began later in the day) and enjoy the creative and collaborative aspects of my job. I don't feel like I'm just punching the clock until I can retire.

Financially, it would be difficult but not impossible for me to retire with Steve.

But as Steve and I chatted over a piece of carrot cake, it occurred to me that this is not an either-or situation. Could I re-jig my work hours? Switch to part-time or contract? Maybe even freelance?

No decisions made, but it's on my mind.

And now what?

Tiramisu, one of life's sweet pleasures.
When I stop wanting it, you'll know it's time to pull the plug.

This is a continuation of yesterday's post wherein I describe my angina attack.


First, thank you for your many caring comments. I have to share a very funny one sent by e-mail from a friend who has experience with heart attacks: "BTW diagnosing yourself from the internet is not what I would describe as the most intelligent thing to do. When you decide to operate on yourself let me know. I will sell tickets."

The yet-to-be-confirmed-by-a-doctor angina attack was a dramatic announcement of my mortality. I pictured the Grim Reaper at the foot of the bed, gesturing a strangulation posture, like Darth Vader.

Throughout the day, I pondered. Maybe a little obsessively.

I don't want to die. I like my life and want to keep living and enjoying it. I want to see my children's weddings, I want to know my grandchildren. I want to relish the beauty of God's world and capture it in my photographs. I want to travel with Stephen. I want to eat tiramisu.

But . . .

• I don't want to live in pain or with disability. 
• I don't want to go blind or lose my toes. (I happen to have very cute feet, thank you.)
• I don't want to give up the things that give me pleasure (yes, I'm thinking about tiramisu). 
• I don't want heart surgery (or a stent or angioplasty or any of those invasive treatments). "Don't want" is really not a strong enough expression for how I feel about this. I am deeply, deeply averse to this.
• Frankly (and I know many of you will be aghast at this), I honestly don't want to exercise, at least not to the degree that would have a significant effect on my health. (A gentle stroll three times a week is not enough to benefit cardiac health, though it is good for my mental health. Most studies and recommendations are for 30-60 minutes of brisk activity every day.)

Steve and I had a difficult talk when I told him these last two points.

He would, of course, like me to be aggressive with my illness and make every effort humanly possible to live a long, happy, healthy life. But he can understand my not wanting to be cut open or pierced.

As for exercise, "You just need to find something you enjoy," he urged. I suppose this could still happen, and if it does, then "Yay!" but even when I've had months of sustained exercise in my daily routine it NEVER became something I enjoyed. I never got those endorphins, never looked forward to it or missed it when I couldn't walk/jog/use the elliptical. Perhaps all those neuroreceptors were occupied with sustaining my overactive appetite?

My point is: I know that I am making a choice and that it has negative effect on my very life. It is selfish, and I am sorry, but there it is. (My inner voice is yelling, "Exercise? You can't make me!" I am stomping my pretty, little foot.)

We agreed that I would, however:

• Follow up with my doctor.
• Take or adjust any medications prescribed.
• Continue to reduce the amount of carbohydrates in my diet with the goal of maintaining my blood sugar.
• Continue to eat smaller portions with the goal of losing weight.

And then we talked about my dad, who died of heart disease a year (almost to the day) of his compulsory retirement at age 65. More about that in my next post.

A Heart Attack Waiting to Happen

CAUTION: I use some strong and possibly offensive language in this post. 

On Friday morning, I woke up in pain.

A hot blanket of diffuse pain wrapped itself around my neck.

It was not a kink in the neck or spinal pain. Moving made no difference to it.

It was not a sore throat; I could swallow, no problem. I could breathe with no difficulty.

It was nothing like anxiety attacks I'd experienced before, the tightening of the throat muscles, that "lump in the throat" feeling.

I practiced relaxation breathing, deeply, slowly in, then slowly and fully out.

The pain did not leave, may have intensified.

Then I remembered an e-mail a friend recently sent me, pointing out that cardiac pain is experienced differently by women than by men. Often they feel it in their neck or jaw rather than in the chest.

"Fuck," I thought. "Fuck fuck fuck."

Then I remembered another tidbit: a cough can be used as self-CPR. [Note: this is anecdotal and Snopes debunks it. If you think you are having a heart attack, stop reading this and get your ass to the emergency room! I was an idiot.]

I coughed lightly. The pain eased.

"Fuck," I thought.

The pain returned, stronger. I coughed harder, several times. The pain went away almost immediately, and I got out of bed.

It did not come back, but as I started googling my symptoms, the telltale signs of migraine aura blotted my vision. I had just enough time to find Prinzmetal's angina, an unusual form of angina that occurs when resting, unlike usual heart symptoms that are triggered by exertion.

I lay in bed with my eyes shut, watching the sparkles and growing blind spot, thinking about death.

When I was first diagnosed with diabetes, the doctor told me that I was at increased risk for heart attack. "As much as if you've already had one heart attack," he said. So here I was.

It wasn't a heart attack, but it was cardiovascular. I was scared and sad, and those feelings stuck with me all day. No, I didn't see a doctor, though it is treatable. ("My" doctor is only at the walk-in clinic on Thursdays and does not make appointments.)

I'll tell you more in tomorrow's post.