Since my last post, I have had one to four medical appointments per week. That’s a little much, no? I consider myself extremely fortunate to live in a country where I don’t have to worry about paying for medical care, but I would still prefer not to need medical care. I can’t help but feel a bit guilty over how much I must be costing the healthcare system, and I really and truly want to make it a little less expensive for them. Here’s a clue: if you just perform the #@*&^ mastectomy now, you won’t have to keep me as a patient across different specialties for so long!
I had my follow-up appointment at the rheumatology department on Monday, June 24. My first appointment was at the end of May, and the young rheumatologist took the most thorough medical history I’ve ever had in Denmark and ordered what seemed to me like every blood test ever invented. SIXTEEN TEST TUBES!!!!! Whatever is wrong with me, this clever rheumie will figure it out. My follow-up was with the senior rheumatologist. All those blood tests showed that I’m basically healthy and don’t have any other scary diseases. (I knew it!) It’s just the usual: hypothyroidism, anemia and vitamin D deficiency. Oh, and I’d be smart to lay off gluten. This doctor told me he’s reading Wheat Belly by Dr. William Davis, which instantly amped his street cred with me.
I’d given up gluten for three months before my first rheumie appointment, so as to test an anti-inflammatory diet. The first rheumie told me to reintroduce gluten for a month and report the results. The second rheumatologist got to hear what happened. Basically, while off gluten, I felt generally better. When I started eating gluten again, I felt generally worse. It was easy to give up gluten when I was in constant pain and going gluten-free made me feel proactive. It is not as easy to give up gluten when a doctor suggests it, because denial kicks in. What do you mean, I could have a real gluten sensitivity? What do you mean, I have to give up croissants? So, I’ve slipped a lot these past few weeks, but I figured out how to outsmart my lack of intrinsic motivation. “If you don’t eat gluten, you’ll feel better,” is not a good enough argument. It’s time to bring out the heavy guns: a sticker chart! When I get 30 consecutive “gluten-free day” stickers on my calendar, I get to buy myself a new pair of Converse All Stars.
The senior rheumatologist had an interesting thought process. He mentioned that out of the other three women who have been treated for Idiopathic Granulomatous Mastitis at Rigshospital over the years, two of them had been taking antidepressants, albeit not the one I’ve been taking. He wondered if my use of Wellbutrin had contributed to the formation of granulomas. He googled “Wellbutrin and granulomas” in front of me and showed me some articles that linked Wellbutrin to liver granulomas. I have some mysterious lesions in my liver that might be granulomas, so this is relevant. He suggested that I stop taking Wellbutrin for three months and report on my progress at the end of September. “It’s summer. Well, what passes for summer in Denmark. It’s sometimes sunny and a bit warm. You are not depressed at the moment. Try stopping Wellbutrin. If that is the cause of the granulomas, they should disappear within a month or two.”
WHOA! I like his train of thought. Stop a medication. I can do that! If Wellbutrin is behind my breast and liver bumps and lumps, and I can be healed by going off it, that would be so simple and so quick! I will also be incredibly pissed off that I took a pharmaceutical that created such horrible side effects, especially because it was a miracle drug for depression. I had no unpleasant side effects, and it worked almost immediately. There’s a reason why they call it the “happy, horny skinny pill.” The same doctor who has accepted my refusal to take methotrexate is suggesting I stop taking my antidepressant. He is not a pill pusher! Actually, he said that if my dose of prednisolone were 10 mg a day, he would insist on switching me to methotrexate, as a steroid-sparing agent. Since my dose is 5 mg, the possible side effects of methotrexate would probably be worse than the possible side effects of prednisolone.
I quit Wellbutrin cold-turkey. I did not experience major withdrawal symptoms, and my mood has been fine so far. I had a headache and was very sleepy the first day off the meds. I couldn’t concentrate on anything the second day off the meds, which was bad, because I had to write my final exam that week. I took Ritalin Uno on days 3, 4 and 5. Focus, energy and productivity returned, and I wrote my exam. I only take Ritalin on an “as needed” basis, so by day 6, I was completely off of psychotropic medication. Guess what? I’m fine. I went to the shrink, and scored a 2 on the Hamilton depression scale. Anything from 0-7 means you’re not depressed. Yay! I’m cured! I’m healed! (Actually, I think the proper term is “remission.”) One major illness down, just a few to go!
I had to increase the dose of prednisolone back to 5 mg daily, because my boob started acting up again on the lower dose. The senior rheumatologist reassured me that 5 mg is such a low dose, that it should not cause lasting side effects. He said it’s equivalent to what my body produces in a day. It should be too low to mess with my bone density and with my metabolism. I reiterated that I refuse to stay on this drug past January 2014. I’d rather cut my boob off that stay on long-term corticosteroids, because there WILL be side effects. He asked me if it wouldn’t be too traumatic for me to go through a mastectomy. I pulled my t-shirt closer to my chest and said, “Look at me. If you cut my left boob off, the size difference between the boob-less side and the other side will be minimal. I don’t think you’ll be able to tell. I don’t need a sick boob. It has no function.” He agreed I had a point, but told me to give the Wellbutrin detox a chance.
I had an appointment with the psychiatrist two days after my rheumatology appointment. It is a bit strange to see a psychiatrist when I am of sound mind. Apparently, being of unsound booby has the potential to send me over the edge, so this is preventative medicine. I got my official diagnoses. On paper. I even had them explained to me. A psychiatric nurse showed me the grounds for diagnosis on the ICD-10 manual and asked me if it seemed accurate. I’m going to be really brave (or really stupid) and write about them. I have periodic unipolar recurrent depression, obsessive compulsive disorder and ADHD. My brilliant sister, nurse Connie, summed up my psychiatric woes: “You have OCD, and I can see that because you make lists over what you want to accomplish. Your ADHD impedes you from accomplishing things, and when you can’t accomplish, you get your periodic depressions.” So, I have your average mild, run-of-the-mill mental issues. I’ve had them all my life, and I have functioned pretty well in spite of them. Every now and then, they act up and interfere, but I can subdue them with cognitive behavioral strategies and psychopharmaceuticals. Maybe giving up gluten will help too.
A week later, I returned to psychiatry for a full somatic workup which showed that, aside from the few things that are wrong with me, I am the picture of health. The doctor strongly recommended that I get a liver biopsy to figure out exactly what those liver masses are. Even though I’m sure they are nothing, and I don’t want to go through an unnecessary procedure, I dutifully agreed. He sent me for more blood work. Apparently, they have this blood panel called a “depression screening” where they test for measurable evidence of other physical conditions that could trigger depression. I feel very well taken care of. I wish everybody had access to universal healthcare of this calibre.
So, I’ve had blood work once a week for the past three weeks. The rheumie sent me, the shrink sent me, and the breast surgery department sent me. I think they just want to keep me anemic. I’m more docile that way. I also had an ultrasound-guided liver biopsy and a quick visit to the ER as a result. More on that on my next post.