June 15, 2000

After waiting patiently since June 3rd, I finally received a copy of the report Blonde Bimbo wrote regarding my June 2nd, 2000 appointment

The enclosure that comes with a cytomel prescription reads as follows, and I quote,

“WARNING:

This product is to be taken with caution and only under a doctor’s supervision by patients with myocardial infarction, angina pectoris, myocarditis, cardiac insufficiency with tachycardia, arterial hypertension.

Patients in this category taking sympathomimetic amines should be monitored. Patients with coronaropathy who are treated with thyroid hormones are to be closely observed during surgery as the likelihood of cardiac arrhythmia can be greater.

At the beginning of CYTOMEL treatment, both diabetics taking either insulin or medicine for hypoglycemia by mouth and patients taking anticoagulant products should undergo laboratory tests to prevent phenomena of alteration and also adapt to a new daily dosage.

Since rare cases have been seen of the patient is recommended to lower the dosage or even stop treatment if he should experience fever or weak muscles, or if the results of laboratory tests for hepatic functioning should so indicate.

Diphenylidantoin must not be injected during CYTOMEL treatment. Patients with panipopituitarism or other problems related to surrenal insufficiency may react unfavorably to thyroxine; patients are thus advised to initiate a corticosteroid based treatment before taking CYTOMEL.”

I, of course had not read the insert until after my June 2nd appointment with the Blonde Bimbo.  When I first started to take cytomel I truly believed that my symptoms improved.  However, a couple of weeks after my January 5th appointment my symptoms reared their ugly heads with a vengeance.   I continued to take cytomel until the beginning of March.  At that point I decided that the cytomel was the only new drug I had introduced into my body so I would quit taking it.  My symptoms however, did not improve.   In desperation I made the June 2nd appointment with Blonde Bimbo.  Blonde Bimbo never once mentioned that a person suffering from hypertension or from hepatic dysfunction in connection with thyroid preparations, or from adrenal dysfunction should heed the warnings on the cytomel information enclosure.

This then is the Blonde Bimbo’s report from my June 2nd, 2000appointment and I quote, “I reviewed Widebertha on June 2nd, 2000 with regards to her fatigue.  As you know, when I last saw Widebertha in early January she felt quite good and attributed this to her combination therapy for her hypothyroidism.  Now she tells me she has had recurrent fatigue since late December or early January.  She has a disturbed sleep pattern which is non-restorative and describes a lot of hip and anterior thigh discomfort at night.   She feels exhausted in the morning.  Energy level begins to improve late morning and she feels best in the afternoon.  Most of her discomfort is in her hip and legs.  She describes achy arms as well and she tells me she is too tired to do housework or go to the office.  She denies any depression.  She denies hot flashes.

Currently she is on Moduret 1 tablet o.d., Metoprolol 25 mg. b.i.d.   Her weight has increased a further 4 kg.  She has no other well defined complaints apart from about an hour of morning stiffness and , as well, a history of one day of some degree of spotting which may have been per vagina or urethral.  As per your forwarded results she had a non-specific rise in liver enzymes in January that is now normal.  An ultra sound of the liver has been normal.  A recent A.M. cortisol was 850 and the P.M. was 550.

Physical examination revealed an overweight middle aged woman.  She was not Cushingoid in appearance.  Her B.P. was 130/80 sitting; pulse was 64 and regular.  On head and neck exam she has a small firm symmetrical thyroid.  Chest, cardiovascular and abdominal exams were essentially normal.  On musculoskeletal exam she has a large number of trigger points in both shoulder and hip girdle.  She is exquisitely tender in particular over the left SI joint.  She has no evidence of any active joint disease peripherally.  Range of movement of her right hip is good.  She has reasonable range of movement of her left hip apart from some difficulty with rotational movements and flexion which cause discomfort.  Right at the present time Widebertha’s clinical presentation is most consistent with fibromyalgia.  I think it would be important to rule out underlying arthritic condition given her more exquisite tenderness in the SI joint, the minor hip findings and the previously transiently abnormal LFT’s for which I do not have a good explanation.  For the present time I have arranged for her to have some x-rays done of her hips and of the SI joints and I have initiated a screen for connective tissue disease.  I have also asked her to do 24 hour urine for free cortisol but apart from the mood changes really there is little here to suggest hypercortisolism.  If these investigations are negative consideration could be given to two therapeutic interventions either together or separately; that is a trial of hormone replacement therapy assuming that her PV bleeding is not on a sinister basis and/or a trial of an h.s, tricyclic to try and improve her sleep pattern  at night.

I have not arranged to see her again at present but certainly will be in contact with her should any of her investigations suggest the need for further work-up.  I will try and forward the investigations to you when they are available.

Thank you for asking me to see this pleasant lady again.”

After the way I was treated by this woman at my June 2nd appointment, she must be incredibly arrogant to add to the end of her report, “Thank you for asking me to see this pleasant lady again!”  Trust me, there will never be a next time but if heaven forbid there is a next time, this pleasant lady will have evolved into a royal pain.

I have included some of the lab results the Blonde Bimbo ordered on June 2nd and they are as follows:

Creatinine was 91 marked high with the lab normals being 53-88

Urine Volume was 2760 marked high with the lab normals being 500 – 1500

Creatinine Clearance was 61 marked low with the lab normals being 80 – 125.

Urine Creatinine per Day was 8567 marked low with the lab normals being 9000 – 18000

Urine Cortisol was 75 with the lab normals being 65 – 300.

The hip x-ray report states that there is no bone or joint abnormality seen.

This entry was posted in Autoimmune disease. Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s