Megestrol is a progesterone derivative with antineoplastic properties used in the treatment of advanced carcinoma of the breast and endometrium. When given in relatively high doses, Megestrol can substantially increase appetite in most individuals, even those with advanced cancer.
Megestrol Acetate Oral Suspension (a form of Megestrol) is used primarily as an appetite enhancer. The method of appetite enhancement is not known, but it can cause high blood sugar.[1]
Currently, it is manufactured under the trade name Megace.[2]
It may cause adrenal insufficiency.[3]
My dad is 81, he has Parkinson's Disease, high blood pressure, and diabetes. Last January he was in the hospital for 2 weeks. After being discharged they sent him to a rehab for 10 days. During that 10 days, he lost 21 pounds and continues to steadily lose weight. Mom is scared because his skin is literally hanging from his body. His appetite does not appear to have changed much, not enough to warrant this consistent weight loss anyway. Mom and I are both puzzled and concerned.
Mom took dad to their primary care doctor a few weeks ago and voiced her concerns. At first the doctor feared a tumor. Which paniced both my parents. She ordered a complete battery of tests, including an MRI. Everything came back normal. So she prescribed Megestrol for my dad because it is supposed to increase the appetite. However, it can also cause high blood sugar. I'm so angry right now I could scream, as his sugar count has been up the last few days. Mom and I have been obsessing over his diet wondering what we gave him which suddenly caused this spike. His doctor should have known about this and either warned him or not prescribed it at all! Why would she prescribe something which such a horrible side effect for a diabetic?!?!
She's my PCP as well and I've never liked her bedside manner, she tends toward bored, surly, or just sad. In 4 years I have never seen this woman crack a smile. I don't expect a doctor to do a comedy routine; but a polite smile of greeting wouldn't hurt. Anyway, I have long suspected she wasn't quite up on the latest medical techniques and information. Looks like I am making a phone call to Aetna in the morning to get dad a new doctor.
Thursday, July 30, 2009
How You Can Overcome Hypothyroidism
Found this on the HuffingtonPost.com and thought it was interesting. I have been battling my thyroid since 1997 when I was diagnosed with Graves Disease. After radioactive iodine treatment and radiation I became severly hypothyroid and overweight for the first time in my life. To say this was depressing is putting it mildly,as I had done runway modeling off and on throughout my 20's.
I know some people think it's a cop out when an overweight person says I have a thyroid condition. I know I thought that even after I was diagnosed as being hypothyroid. I figured the key to losing weight was a better diet and exercise. I joined Weight Watchers and counted points religiously. I started walking during my lunch hour and after work. When that did nothing, I surmised that I needed to kick my workout up a notch and joined Curves with some women from work. They recommend going 3 days a week. I went for 4 or sometimes 5 days a week. After 8 months,I had lost inches in the oddest placeslike my wrists. Plus, I had lost and gained the same 8 pounds more than I care to remember. I had my thyroid bloodwork checked every 60 days in addition to taking Levoxyl, finally after a few years of this I just gave up.
I'm gonna give this doctor's suggestions a try; and see if it works for me. Lord knows, at this point it can't hurt.
How You Can Overcome Hypothyroidism
I encourage you to take the following steps to rebalance your thyroid:
1. Make a thorough inventory of any of the symptoms that I mentioned in last week's blog to see if you might suffer from hypothyroidism.
2. Get the right thyroid tests including TSH, free T3, free T4, TPO, and anti-thyroglobulin antibodies.
3. Check for celiac disease with a celiac panel.
4. Consider heavy metal toxicity.
5. Check your vitamin D level.
Once you have confirmed that a sluggish thyroid is contributing to your symptoms, the good news is that there are many, many, many things you can do to help correct thyroid problems.
I have developed a seven-step plan to address hypothyroidism:
1. Treat the Underlying Causes -- Identify and treat the underlying causes of hypothyroidism, like food allergies, gluten, heavy metals, nutritional deficiencies, and stress.
2. Optimize Your Nutrition -- Support your thyroid with optimal nutrition, including foods that contain iodine, zinc, omega-3 fats, selenium, and more.
3. Minimize Stress -- Eliminate adrenal exhaustion and minimize stress by engaging in a comprehensive stress management program.
4. Exercise -- Engage in thyroid stimulating exercise, which boosts thyroid function.
5. Supplement -- Use supplements to help enhance thyroid function, including all the nutrients needed for proper thyroid metabolism and function.
6.Heat Therapy -- Use saunas and heat to eliminate stored toxins, which interfere with thyroid function.
7. Thyroid Hormones -- Use thyroid hormone replacement therapy to help support your thyroid gland.
I believe a comprehensive approach is needed to address chronic thyroid issues and to diagnose them. Unfortunately, most of the options for healing by conventional care are quite limited and only provide a partial solution. But by following my seven-step plan you can achieve lifelong vibrant health.
I know some people think it's a cop out when an overweight person says I have a thyroid condition. I know I thought that even after I was diagnosed as being hypothyroid. I figured the key to losing weight was a better diet and exercise. I joined Weight Watchers and counted points religiously. I started walking during my lunch hour and after work. When that did nothing, I surmised that I needed to kick my workout up a notch and joined Curves with some women from work. They recommend going 3 days a week. I went for 4 or sometimes 5 days a week. After 8 months,I had lost inches in the oddest placeslike my wrists. Plus, I had lost and gained the same 8 pounds more than I care to remember. I had my thyroid bloodwork checked every 60 days in addition to taking Levoxyl, finally after a few years of this I just gave up.
I'm gonna give this doctor's suggestions a try; and see if it works for me. Lord knows, at this point it can't hurt.
How You Can Overcome Hypothyroidism
I encourage you to take the following steps to rebalance your thyroid:
1. Make a thorough inventory of any of the symptoms that I mentioned in last week's blog to see if you might suffer from hypothyroidism.
2. Get the right thyroid tests including TSH, free T3, free T4, TPO, and anti-thyroglobulin antibodies.
3. Check for celiac disease with a celiac panel.
4. Consider heavy metal toxicity.
5. Check your vitamin D level.
Once you have confirmed that a sluggish thyroid is contributing to your symptoms, the good news is that there are many, many, many things you can do to help correct thyroid problems.
I have developed a seven-step plan to address hypothyroidism:
1. Treat the Underlying Causes -- Identify and treat the underlying causes of hypothyroidism, like food allergies, gluten, heavy metals, nutritional deficiencies, and stress.
2. Optimize Your Nutrition -- Support your thyroid with optimal nutrition, including foods that contain iodine, zinc, omega-3 fats, selenium, and more.
3. Minimize Stress -- Eliminate adrenal exhaustion and minimize stress by engaging in a comprehensive stress management program.
4. Exercise -- Engage in thyroid stimulating exercise, which boosts thyroid function.
5. Supplement -- Use supplements to help enhance thyroid function, including all the nutrients needed for proper thyroid metabolism and function.
6.Heat Therapy -- Use saunas and heat to eliminate stored toxins, which interfere with thyroid function.
7. Thyroid Hormones -- Use thyroid hormone replacement therapy to help support your thyroid gland.
I believe a comprehensive approach is needed to address chronic thyroid issues and to diagnose them. Unfortunately, most of the options for healing by conventional care are quite limited and only provide a partial solution. But by following my seven-step plan you can achieve lifelong vibrant health.
EGD - Update
My EGD was a breeze! No pain or even a scratchy throat after the procedure. But I am was so sleepy.
They told me to arrive at 7:00 AM, we were a tad late, got there at 7:10 AM. The procedure was supposed to start at 8:30 but it was closer to 10:00 AM. Man was that place busy! I mean people were in and out,in and out,the entire time. Any who, through the fog of anesthesia I think I heard the doctor say I was okay. Which is good and bad. Apparently, I am the only person on the planet who gets severe acid reflux for no apparent physical or dietary reason.
They told me to arrive at 7:00 AM, we were a tad late, got there at 7:10 AM. The procedure was supposed to start at 8:30 but it was closer to 10:00 AM. Man was that place busy! I mean people were in and out,in and out,the entire time. Any who, through the fog of anesthesia I think I heard the doctor say I was okay. Which is good and bad. Apparently, I am the only person on the planet who gets severe acid reflux for no apparent physical or dietary reason.
Wednesday, July 29, 2009
EGD - Esophagogastroduodenoscopy
Lucky me, in a few hours I get to have my first EGD!
EGD - Esophagogastroduodenoscopy
In medicine (gastroenterology), esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anaesthesia has been used). A sore throat is also common.[1][2][3]
Indications
Diagnostic
• Unexplained anemia (usually along with a colonoscopy)
• Upper gastrointestinal bleeding as evidenced by hematemesis or melena
• Persistent dyspepsia in patients over the age of 40-45 years
• Heartburn and chronic acid reflux - this can lead to a precancerous lesion
called Barrett's esophagus
Persistent vomiting
• Dysphagia - difficulty in swallowing
• Odynophagia - painful swallowing
Surveillance
• Surveillance of Barrett's esophagus
• Surveillance of gastric ulcer or duodenal ulcer
• Occasionally after gastric surgery
Confirmation of diagnosis/biopsy
• Abnormal barium swallow or barium meal
• Confirmation of celiac disease (via biopsy)
Therapeutic
• Treatment (banding/sclerotherapy) of esophageal varices
• Injection therapy (e.g. epinephrine in bleeding lesions)
• Cutting off of larger pieces of tissue with a snare device (e.g. polyps, endoscopic mucosal resection)
• Application of cautery to tissues
• Removal of foreign bodies (e.g. food) that have been ingested
• Tamponade of bleeding esophageal varices with a balloon
• Application of photodynamic therapy for treatment of esophageal malignancies
• Endoscopic drainage of pancreatic pseudocyst
• Tightening the lower esophageal sphincter
• Dilating or stenting of stenosis or achalasia
• Percutaneous endoscopic gastrostomy (feeding tube placement)
• Endoscopic retrograde cholangiopancreatography (ERCP) combines EGD with fluoroscopy
• Endoscopic ultrasound (EUS) combines EGD with 5-12 MHz ultrasound imaging
Newer interventions
• Endoscopic trans-gastric laparoscopy
• Placement of gastric balloons in bariatric surgery
Procedure
The patient is kept NPO (Nil per os) or NBM (Nothing By Mouth) that is, told not to eat, for at least 4-6 hours before the procedure. Most patients tolerate the procedure with only topical anaesthesia of the oropharynx using lidocaine spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anaesthetic, such as midazolam. Informed consent is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed.
The patient lies on his/her left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. The endoscope is then passed over the tongue and into the orpharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus making note of any pathology. Excessive insufflation of the stomach is avoided at this stage. The endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of the duodenum. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed including a J-maneuver. This involves retroflexing the tip of the scope so it resembles a 'J' shape in order to examine the fundus and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Still photographs can be made during the procedure and later shown to the patient to help explain any findings.
In its most basic use, the endoscope is used to inspect the internal anatomy of the digestive tract. Often inspection alone is sufficient, but biopsy is a very valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy forceps) which is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.
Biopsy allows the pathologist to render an opinion on later histologic examination of the biopsy tissue with light microscopy and/or immunohistochemistry. Biopsied material can also be tested on urease to identify Helicobacter pylori.
EGD - Esophagogastroduodenoscopy
In medicine (gastroenterology), esophagogastroduodenoscopy is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure (unless sedation or anaesthesia has been used). A sore throat is also common.[1][2][3]
Indications
Diagnostic
• Unexplained anemia (usually along with a colonoscopy)
• Upper gastrointestinal bleeding as evidenced by hematemesis or melena
• Persistent dyspepsia in patients over the age of 40-45 years
• Heartburn and chronic acid reflux - this can lead to a precancerous lesion
called Barrett's esophagus
Persistent vomiting
• Dysphagia - difficulty in swallowing
• Odynophagia - painful swallowing
Surveillance
• Surveillance of Barrett's esophagus
• Surveillance of gastric ulcer or duodenal ulcer
• Occasionally after gastric surgery
Confirmation of diagnosis/biopsy
• Abnormal barium swallow or barium meal
• Confirmation of celiac disease (via biopsy)
Therapeutic
• Treatment (banding/sclerotherapy) of esophageal varices
• Injection therapy (e.g. epinephrine in bleeding lesions)
• Cutting off of larger pieces of tissue with a snare device (e.g. polyps, endoscopic mucosal resection)
• Application of cautery to tissues
• Removal of foreign bodies (e.g. food) that have been ingested
• Tamponade of bleeding esophageal varices with a balloon
• Application of photodynamic therapy for treatment of esophageal malignancies
• Endoscopic drainage of pancreatic pseudocyst
• Tightening the lower esophageal sphincter
• Dilating or stenting of stenosis or achalasia
• Percutaneous endoscopic gastrostomy (feeding tube placement)
• Endoscopic retrograde cholangiopancreatography (ERCP) combines EGD with fluoroscopy
• Endoscopic ultrasound (EUS) combines EGD with 5-12 MHz ultrasound imaging
Newer interventions
• Endoscopic trans-gastric laparoscopy
• Placement of gastric balloons in bariatric surgery
Procedure
The patient is kept NPO (Nil per os) or NBM (Nothing By Mouth) that is, told not to eat, for at least 4-6 hours before the procedure. Most patients tolerate the procedure with only topical anaesthesia of the oropharynx using lidocaine spray. However, some patients may need sedation and the very anxious/agitated patient may even need a general anaesthetic, such as midazolam. Informed consent is obtained before the procedure. The main risks are bleeding and perforation. The risk is increased when a biopsy or other intervention is performed.
The patient lies on his/her left side with the head resting comfortably on a pillow. A mouth-guard is placed between the teeth to prevent the patient from biting on the endoscope. The endoscope is then passed over the tongue and into the orpharynx. This is the most uncomfortable stage for the patient. Quick and gentle manipulation under vision guides the endoscope into the esophagus. The endoscope is gradually advanced down the esophagus making note of any pathology. Excessive insufflation of the stomach is avoided at this stage. The endoscope is quickly passed through the stomach and through the pylorus to examine the first and second parts of the duodenum. Once this has been completed, the endoscope is withdrawn into the stomach and a more thorough examination is performed including a J-maneuver. This involves retroflexing the tip of the scope so it resembles a 'J' shape in order to examine the fundus and gastroesophageal junction. Any additional procedures are performed at this stage. The air in the stomach is aspirated before removing the endoscope. Still photographs can be made during the procedure and later shown to the patient to help explain any findings.
In its most basic use, the endoscope is used to inspect the internal anatomy of the digestive tract. Often inspection alone is sufficient, but biopsy is a very valuable adjunct to endoscopy. Small biopsies can be made with a pincer (biopsy forceps) which is passed through the scope and allows sampling of 1 to 3 mm pieces of tissue under direct vision. The intestinal mucosa heals quickly from such biopsies.
Biopsy allows the pathologist to render an opinion on later histologic examination of the biopsy tissue with light microscopy and/or immunohistochemistry. Biopsied material can also be tested on urease to identify Helicobacter pylori.
My 2nd Sonohysterogram
Ladies, if you ever have to get a sonohysterogram, be forewarned...it HURTS!!!!
They told me to take 800 mgs. of ibuprofen an hour before the appointment. Not being a morning person of course I forgot to do this. So I had the procedure without any type of pain killer. How I drove home, I don't know, but I did. I then proceeded to try to nap the rest of the day. I say try, because mom kept waking me up for no good reason, the contractors were there to put down the new floor, and the A/C kept cutting off on a humid 85F day.
Oops! Almost forgot the most important part! I have another uterine fibroid which is why I had the 17 day period from hell. This one is much smaller, only 1cm, the doctor said. So I have to have another hysteroscopic myomectomy. They will call me later this week to schedule this surgery.
They told me to take 800 mgs. of ibuprofen an hour before the appointment. Not being a morning person of course I forgot to do this. So I had the procedure without any type of pain killer. How I drove home, I don't know, but I did. I then proceeded to try to nap the rest of the day. I say try, because mom kept waking me up for no good reason, the contractors were there to put down the new floor, and the A/C kept cutting off on a humid 85F day.
Oops! Almost forgot the most important part! I have another uterine fibroid which is why I had the 17 day period from hell. This one is much smaller, only 1cm, the doctor said. So I have to have another hysteroscopic myomectomy. They will call me later this week to schedule this surgery.
Monday, July 27, 2009
A Come to Jesus Meeting
I think I need to have a come to Jesus meeting, with God. I've held up my end of the deal often going above and beyond what was necessary. Not just to be a good daughter, but a good person, and hopefully a good Christian. I know I'm an excellent worker, yet he struck me with one serious illness after another until I had to stop working. I don't want to be disabled; I damn sure don't want a handout. But if God isn't going to allow me to collect SSD, then he needs to step up to the plate and find me a decent job.
There has obviously been a mistake, God seems to think I am to be a modern day Job. Lest you think I exaggerate, in the last 3 years I have been stricken/blessed with: vulvar cancer, Meniere's disease, uterine fibroids the size of North Dakota, diverticulosis, psoriasis - not on my elbows like most people, but on my scalp, ears, and nose. FYI - When you get psoriasis on your scalp, it takes out your hair. You could say I'm irked, but that really doesn't do my current emotional state justice. Speaking of my emotional state, I seem to be fighting a never ending uphill battle against major depressive disorder and generalized anxiety disorder.
Did I mention that dad's Parkinson's has kicked into overdrive, seemingly overnight. Mom's doctor says she is in the early stages of dementia. Which means that I am now a caregiver to my adult parents. It SUCKS for all of us in different ways, at different times. For me it's like living with 80 year old toddlers. Willfull, spoiled, adult size toddlers. Occassionally I worry that I will get some great job in Atlanta and have to hire people to chauffer and care for my parents. However, with the economy in the crapper, and double digit unemployment rates, not just in Carroll County but in the entire state of Georgia, it seems I am putting the cart before the horse.
This is not how my life was supposed to be. I was supposed to be married with a few kids, a dog, and a house in the burbs by now.
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