Finally Reading The Sourcebook

Yesterday, after eighteen years as the wife of a cancer survivor, I finally started reading The Thyroid Sourcebook by M. Sara Rosenthal, Ph.D.  The first edition of this book (now it its fifth edition) was published in 1993, the year King Richard was diagnosed with medullary carcinoma of the thyroid, a dangerous, often hereditary, type of cancer that does not respond to radioactive iodine or radiation therapy.  So why now?  Why read the premier book on thyroid treatment after all these years?  Well, for one, I wanted to make sure I had the latest information on follow-up care for my husband and, two, I wanted to offer the book to the family of a newly engaged young couple at church (the bride has been diagnosed with thyroid disease) and I couldn't do that in good conscience without first reading the volume.

Living with a thyroid patient is no picnic.  Every day means dealing with some manifestation of two issues:  the reality of a physiology with a compromised organ (or, in my husband's case, no organ) and the reality of a medication that has side effects.  Most days, I am uncertain which is going to show up, biochemically speaking, but whichever issue makes an appearance, I try to cope with grace.  Note the symptoms of each issue;  those in bold are the ones I have had to deal with over the years.

Hypothyroidism	Synthroid® Side Effects
Fatigue	Rapid or irregular heartbeat
Sluggishness	Chest pain, breathing issues
Increased sensitivity to cold	Muscle weakness
Pale, dry skin	Nervousness
Puffy face	Irritability
Hoarse voice	Sleeplessness
Elevated blood cholesterol level	Tremors
Unexplained weight gain	Change in appetite
Muscle aches, tenderness, stiffness	Weight loss
Pain, stiffness, joint swelling	Vomiting
Muscle weakness	Frequent bowel movements
Brittle fingernails & hair	Excessive sweating
Depression	Heat intolerance
Forgetfulness, slow thinking	Fever
	Impaired fertility
	Decreased bone density
	Other unusual medical events

Most, if not all, of these symptoms are relatively mild or nonexistent for my husband these days, either that or I have become so inured to them after eighteen years that they only seem mild to me now.  It wasn't always like that.  The first few months after surgery were a very different story, as our first endocrinologist tried to settle on an optimal Synthroid® dosage for King Richard.  She eventually had him taking 325 mcg of levothyroxine daily, an amount we later discovered was so high that, most of the time, my poor husband walked around in a state of profound hyperthyroidism as his doctor attempted to force his TSH (thyroid stimulating hormone) level to register zero on a bloodwork run.  Such was the accepted therapy for medullary thyroid cancer at that time, thinking that suppression of TSH would prevent recurrence.  At least that is what we were told back in the early 1990's.  Thankfully, my husband and I eventually found our way to an excellent specialist who adjusted his Synthroid® dose down to a more normal level (~175 mcg), not in the stratosphere.

So why do I want this young couple to be armed with the information in this book?  Quite simply:  divorce.  Over the years, King Richard and I have encountered a number of couples that have dealt with some kind of thyroid disease, be it thyroid cancer, Graves disease, or hypothyroidism.  To date, of the couples we know in our locale that have had to deal with thyroid cancer, ours is the only marriage still intact.  I do not say that to brag, nor do I say it lightly.  As I said before, living with a thyroid patient is no picnic.  Ending up with a thyroid patient after several years of marriage is one thing.  Taking on a thyroid patient as a "young couple in love" and having little or no knowledge of what you are getting into could be disastrous;  at the very least, it could lead to years of emotional damage.

So...I will offer the book to them when I am finished with it.  Hopefully, they will find it helpful and will graciously listen to an elder who has walked the path before them.  If not, then I will continue to make myself available to them for advice and counsel should they ever have the need or the desire to ask for it.

That Darn Joint

Two days ago, after a week or so of some very mild muscle tugging in the area of my sacroiliac joint, my lower back finally "locked up."  This hasn't happened since late June when I got TOTALLY stressed out preparing for our summer vacation.  I am unsure why it happened now.  I am not particularly stressed about anything.  I usually suffer from "lock ups" during periods of great demands on my time, when I have many competing goals and pressing deadlines.  As "lock up" events go, this one is pretty tame, giving me only short periods of incapacitation if I forget to take a dose of ibuprofen.  When my daughter was younger, some episodes were so severe I could barely walk without the assistance of a cane or crutches.  I guess all that chiropractic care I paid for (and continue to pay for) is helping.

I am definitely irritated with my body.  My 50th birthday is on Friday and I have a short field trip planned that requires quite a bit of walking.  In an effort to find a "quick" remedy so I am ready for my excursion, I started searching for a solution.  Imagine my surprise when I discovered that my sacroiliac joint may not be "locked up" after all but might be misaligned instead due to too much flexibility.  An imbalance in the tightness of my calf muscles (the right side being worse) or stiffness in the sacroiliac joint itself (or both) may be creating inflammation that is probably causing the pain, confirmed by the fact that ibuprofen is effectively addressing most of the discomfort at the moment.  The fact that I was neglecting my daily "before I hop out of bed" stretching routine surely didn't help, either.

So, I have three days to heal.  Hopefully, my almost 50-year-old body cooperates.

Yoga Journal article on sacroiliac joint

Maple Sugar Pie

Last night, my daughter cooked dinner for a family friend and us.  Menu:  kidney beans with sausage and red wine (from James Beard's American Cookery) and, for dessert, maple sugar pie.  The first dish was new;  the second was a repeat.  I believe this is the third time she has tried the pie recipe.  The first time, it came out with a thick sugary layer on the bottom and light yellow custard on top.  The second time the layers were completely integrated, but she used brown sugar like the original recipe.  This time, the layers were integrated as before, but maple sugar was the sole sweet ingredient.  Next time, I am hoping she uses maple extract instead of vanilla so the pie is unmistakably maple flavored and not just somewhat maple flavored.  She started with this recipe from Circle B Kitchen and tweaked it a bit by substituting maple sugar for the brown sugar.  Warning:  this pie is really sweet so if you are prone to tooth decay, brush after eating it.  If you are diabetic or are prone to insulin issues, I would skip it altogether.  It is yummy, but I don't eat it very often.  The pie is very fall-like and makes the entire house smell like autumn when it is baking.  By the way, if you ever need a dessert for a church potluck, men love it!

Gum Measurements & A Care Plan

Recently, I had my semi-annual dental cleaning, during which my hygienist, Tiffany measured my gums.  This time, as she was calling out the numbers to her colleague (e.g., 3, 2, 3, 2, 2, 3, 1, 2, 1), I heard a one.  A one!  I had never, ever gotten a one!  I don't think I even had a one when I was a kid.  I have absolutely no idea what I did to deserve a one, but I got one.  That got me wondering if average people, like me, know what those numbers mean.  I didn't.  So, I looked it up.

Gum measurements are performed with a tool called a periodontal probe that is calibrated in millimeters to ascertain the size of the gum pocket next to each month.  The probe is slid down next to the root of the tooth until it encounters resistance from the gum tissue.  The mark on the probe i them read, indicating the depth of the gum pocket.  For a clear illustration of what this process looks like, visit this website.  All gums have pockets, but healthy pockets neither bleed nor are they deeper than 2 mm.  So, if your hygienist calls out numbers less than three, relax.  You are doing a good job managing your gum health.

These gum measurements are keyed to stages of periodontal health/disease.  Gum pocket depths of 1-3 mm with no gum puffiness and no gum bleeding are indicative of healthy gum tissue.  If your gums bleed when they are measured, or if they are puffy in appearance but still have pocket depths of 1-3 mm, you have gingivitis (or Stage I periodontitis).  Stage II periodontitis presents with gum bleeding and gum puffiness but pocket depths of 3-5 mm, deeper than in Stage I.  Stage III gum disease begins with pocket depths greater than 5 mm;  at this point gums are not just puffy, they are swollen and beginning to recede.

So, what to do?  According to the American Dental Association, the recommended care plan to prevent gum disease includes the following steps:

1.  Brush twice daily using a soft-bristled toothbrush.
2.  Clean between teeth daily using floss or an oral irrigator.*
3.  Use a tongue cleaner daily to remove bacteria.
4.  Eat a balanced diet.
5.  Visit the dentist regularly.
6.  Reduce or eliminate activities that cause or increase periodontal disease (i.e., smoking, etc.).

Since my gum pocket depths are in the normal range (1-3 mm), I have generally healthy gums.  That said, I do have occasional gum bleeding and puffiness, so it would be wise for me to follow a dental health plan geared toward addressing gingivitis.  That is what I am doing at the moment.  I will adjust this routine depending on the results of my next dental exam (in the spring of 2012).

AM (after waking)
- brush with a tartar control toothpaste that contains fluoride
- floss with tape-type dental floss
- use dental rinse* to promote healthy gums

After eating and/or before leaving the house
- brush with regular or tartar control toothpaste
- floss with tape-type dental floss

PM (bedtime)
- brush with a tartar control toothpaste that contains fluoride
- floss with tape-type dental floss
- use dental rinse* or dry mouth rinse

Remember:  periodontal or gum disease is a chronic infection, which means that it cannot be cured.  It can only be managed by reducing/controlling the bacteria and other factors that contribute to a full-blown manifestation of the condition, usually resulting in tooth loss.  According to the American Dental Association, as of April 2010, periodontal disease affects more 80% of the adult population in the United States.  Given that statistic, chances are good that you may eventually be dealing with it in your own household, so visit your dentist today and get a care plan for you and for your family members.

*The Natural Dentist

Note:  No compensation was received for featuring any product in this post.

Nine Warning Signs

Many thanks to Koalagirl for posting this on her Facebook page.  Her mother passed away recently after spending six years as an Alzheimer's patient.  Below is a summary of the nine warning signs of the illness that were mentioned in the article:

1.  You experience chronic problems with short-term memory.  You forget what you ate for breakfast;  you can't recall your wedding date after twenty-five years of marriage;  or you repeatedly ask for the same information.

2.  Math-related tasks become more difficult.  Budgeting for your monthly bills or doubling a recipe used to be a snap.  Now it takes more time, or it can be downright confusing.

3.  Daily routines may not make sense.  You draw a blank on how to get to your favorite store or you forget how to update your Facebook page (assuming Mark Zuckerberg hasn't changed the method lately).  This is especially concerning if your "blank spots" are frequent and related to everyday things.

4.  Your ability to judge distance and time is off.  You might hit your brakes too hard when approaching a red light, spatial relationships may not compute, or your sense of time is distorted.

5.  You lose personal items.  The key here is the frequency with which it occurs.  You may also find that retracing your steps to find the lost items becomes less successful.

6.  You increasingly have trouble expressing yourself.  You may also find that following or participating in a conversation becomes more difficult.

7.  You make rash decisions or you no longer know how to react in certain situations.  Cookies are burning in the oven and you have no idea what to do;  you walk across a busy intersection on a red light because you don't remember what a red light means;  or you donate an unreasonable sum of money to your favorite charity.

8.  You interact with people less and less.  You may also notice that your mood swings wildly, something that may be unusual for you.  You may feel depressed or anxious or fearful for no reason.

9.  You are diabetic.  Diabetes doubles your risk of developing Alzheimer's disease.  Blood sugar issues, as well as high blood pressure, heart disease, and high cholesterol, can also put you at risk for brain cell damage that can lead to dementia.

Remember:  simple, occasional occurrences of any of these issues are not generally a problem.  However, if they become frequent or disruptive to daily life or relationships, you should seek medical attention in a timely manner.  Early diagnosis of Alzheimer's disease is key to proper management of the condition and better living for a longer period of time.

Optimism = Brain Malfunction?

I heard a news report this morning that optimism may be due to a brain malfunction.  So, that must mean that my eighty-year-old mother is dysfunctional because she is one of the most optimistic and, I might add, well-adjusted people I know.  Given that news headlines tend to be slightly inaccurate, I decided to see if I could get the scoop, so to speak.

The journal Nature Neuroscience published the results of a study about unrealistic optimism.  Here is their description of the article from their website.  I couldn't read it as I lack the necessary subscription, plus I wasn't willing to pay $32.00 for instant-read privileges:

Unrealistic optimism is a pervasive human trait that influences domains ranging from personal relationships to politics and finance.  How people maintain unrealistic optimism, despite frequently encountering information that challenges those biased beliefs, is unknown.  We examined this question and found a marked asymmetry in belief updating.  Participants updated their beliefs more in response to information that was better than expected than to information that was worse.  This selectivity was mediated by a relative failure to code for errors that should reduce optimism...These findings indicate that optimism is tied to a selective update failure and diminished neural coding of undesirable information regarding the future.

Unable to access the "horse's mouth," if you will, I looked elsewhere online to get some information.  Here are two headlines that I encountered;  interesting how one sounds optimistic and the other...well...doesn't:

"Human Brain is Optimistic 80% at a Time"
"Is Your Glass Always Half Full?  Optimism Could Be Down to a Brain Malfunction"

It is important to remember that the study focused on "blind" or unrealistic optimism:  the belief that positive (or negative) events are more (or less) likely to happen to you personally versus someone else.  The study results found that people who are very optimistic tend to pay attention to information that reinforces their previously held optimistic belief.  Health wise, that can be a good thing;  it can lower stress and anxiety levels.  On the downside, it can mean that people fail to react or respond appropriately to precautions.

The brain malfunction part comes from the fact that, when presented with information that suggested a better-than-perceived event outcome, all study participants showed increased activity in their frontal lobes.  But then, when the information presented led to a worse-than-expected event outcome, the more optimistic study subjects showed less activity in those same frontal lobes, meaning they were disregarding the new evidence.  Apparently, that disparity in frontal lobe activity could be the result of a brain malfunction.  Easier-to-understand conclusion:  we pick and choose the information we listen to.

I don't know about you, but I pretty much knew that about myself and, for that matter, other people.  Does that mean that we all have a brain malfunction?  As a layperson with absolutely no experience in this field of research, I am unsure if I can agree with these study results.  The brain is pretty malleable.  Isn't it possible that the "selectivity" response to information that was observed in the study is a learned, adaptive response rather than a structural problem?  Sounds like it may be time for further study.

Another perspective on this topic from October 2007:  Viewing Life Through a Rose-Colored Cortex.

Caution: Video Game Eyes

Yesterday morning when I awoke, after staying up until 2:30 AM writing an e-mail to a friend, I thought my Saturday activities would be consigned to such home bound chores as laundry, bleaching my dehumidifiers, and preparing my window air conditioner for winter storage.  Instead, I ended up taking my daughter to the eye doctor for an emergency check up.

Eye diagram showing ciliary muscles

On Friday evening, Katherine the Great informed me that she had been experiencing double vision and blurriness for almost a week.  "I thought it would clear up by itself," she said.  Well, it didn't, prompting the aforementioned visit.  After a very thorough examination, the diagnosis was a spasm of accommodation.  Her eye muscles essentially locked themselves into a nearsighted focus due to overuse.  She had been working on her computer, reading a lot for a literature class...and playing a video game on her iPhone a bit too much.  Prescription:  muscle relaxant eye drops (one dose only), rest, and dark glasses to protect her eyes while dilated (a side effect of the eye drops).  In addition, she needs to be much more judicious about taking short breaks when doing close work, like studying, writing on her laptop, or playing a video game (which she really doesn't do all that often, all current evidence to the contrary).

The culprit in this case was an old diversion called Shining Force (1992).  My daughter and her best friend discovered it when they were much younger and were playing it for nostalgia reasons.  Thankfully, his eyes are fine.  He feel terrible, though, that hers reacted badly to their little excursion down memory lane.  Fortunately, Katherine the Great and her vision will be fine.  She just needs to be a bit smarter about her technology use.

I Met a Food Blogger

Norwegian Beef Pot Roast
Photo by Plush Duck

Yesterday evening, after having a slice of coconut custard pie at The Shack with Koalagirl, King Richard and I made a trip to the grocery store to pick up milk and prunes for some Sunday recipes.  After that, we headed to the liquor store for a bottle of red wine, an ingredient in the Norwegian pot roast that Katherine the Great decided to cook today.  While in the imported wine aisle, my husband and I were discussing some of the other recipe ingredients --- garlic, onions, ginger, green olives --- and wondering if a Malbec would blend well with them.  Just then, a woman who was standing nearby interjected with a suggestion:  a Pinot Noir.  This initiated a nice conversation about the dish we were creating, during which she shared that she was a food blogger at AlmostItalian.com.  Tonight, we had the Norwegian pot roast for dinner, made with a Malbec so that we had something nice to drink with it.  Accompanied by some steamed vegetables, a Bergenost Norwegian-style cheese that I bought at the last minute and some crusty bread, topped off by a small dish of Norwegian rice pudding, it made for a wonderful meal.  Many thanks to Ms. Chase for all her help and for the pleasantly unexpected chat.

Note:  No compensation was received for featuring any establishments or products in this post.