Niacin Nightmare

Here's how my Sunday night went. How was yours?

My physician and the pharmacist were not kidding - niacin flushing is a nightmare. I took my 500mg pill around 9:45 p.m., knowing full well what I could expect. For about 14 minutes, I thought I was in the clear. Then suddenly I grew very, very warm and my skin began to crawl. I looked down at my arm and saw the proof. Naturally, I stripped to see if it was everywhere and oh boy was it. By 10:15 I was miserable, and by 10:30 I was inconsolable. It felt like a third degree sunburn - hot hot hot skin, burning, and chills. Fortunately, no itch. I was wide awake (another problem in itself) so I popped some Benadryl and within 45 minutes, it was finally taking the edge off. I fell asleep by 11:30, but the Benadryl still hadn't worn off when my alarm went off at 6 a.m., so I let myself go back to sleep unti 8:30.

Tonight, my plan is to some baby aspirin about 30 minutes prior to taking the niacin, but still keep the Benadryl close by. The aspirin reduces the flushing. However, the flushing means it's working, so hopefully my body starts adjusting to this new bedtime routine soon.

My Cholesterol Needs to Take a (Downhill) Hike

Want to be baffled? Then read on...

First of all, refresh your memory by reading out my annual physical in February. Yeah, numbers all over the place. So here are the steps I took at my physician's recommendation:
1. A bowl of low sugar oatmeal every morning with a tablespoon of ground flaxseed.
2. Six days a week of exercise.
3. Cut back on meat - I gave up all meat for five weeks. I couldn't make it through all of Lent, but I came within 10 days and still only ate meat a few times since then.
4. Limit dietary cholesterol - I ate a whole egg some mornings, or just egg whites other mornings. I still never came close to the 300mg/day limit my physician set even with the occasional slice of pizza, shrimp, or processed foods containing high amounts of cholesterol.
5. Reduce my beta blocker (propranolol) from 10mg/day to 5mg/day. This drug has been prescribed to me since February 2010 when I was diagnosed with Graves' disease to control my rapid heart rate. However, it is known to increase LDL (bad cholesterol), so I have been weaning off of it.
6. Increase intake of nuts, beans, olive oil, fish.
7. Decrease intake of sweets.

And what was the result eight weeks later? My total cholesterol went up by 14mg/dl. Are you f-ing kidding me?! I knew something was up as soon as my physician walked in the room. She gave me that, "Aw, too bad," look and said, "Well, at least your thyroid levels are good." Which was encouraging for about .2 seconds until I realized that they have been good before, but that never lasts for more than 6-8 weeks because my now-deceased thyroid is still a motherf****r.

The breakdown:

So, my triglycerides came down by a whopping 1mg/dl, but my HDL (good cholesterol) went down by 3.1 and my LDL went up by 17. How is that even possible, given all I've done to improve it?

Well, my physician and I are just as dumbfounded as you probably are.

My mom's side of the family has high cholesterol. However, almost everyone on my mom's side of the family has a poor diet and does not exercise that I am aware of. So I'm not going to accept that it's just genetics. It's bullsh*t is what it is.

I sat in her office and cried while she looked up every possible link between Graves' and radioactive iodine ablation and omeprazole and Synthroid and GI issues. Nothing.

So my options are 1. have a heart attack at 28 and croak. 2. start taking a statin. or 3. find other ways to lower my LDL. Taking a statin really is not an option as a woman of child-bearing age. Statins cause birth defects, in addition to a whole host of serious side effects on the individual as well. So my physician prescribed (well, recommended really, since it's OTC) 500mg/day of niacin, which is a B3 vitamin that has been proven to improve cholesterol. I am reading different articles on how it lowers LDL, and others about how it increases HDL. So I'm not really sure which it is, but I am willing to try anything that isn't a prescription drug. I've also decided to go meatless Monday-Friday lunchtime, and chill out on egg yolks and shrimp and other cholesterolly (yup, that's a word now) foods.

The niacin scares me a bit. It causes flushing, and is known to cause more extreme flushing in people with fair, sensitive skin. Not blushing, but flushing. Redness, itching, pure discomfort for anywhere from 15-30 minutes to two hours. So since I had three drinks (over the course of six hours, but still) last night trying to drown my sorrows, I decided it was best not to take the niacin, at least not for the first time, with alcohol in my system. I'll try it tonight.

I'm about as dejected as I could possibly be. This was the week from hell with work and my huge Junior League project being tossed out because of possible EPA violations and serious health risks. Not anything we did, but the organization with which we were planning to work, and there's no way in hell I was putting myself and my members at risk. It's unfortunate because it was six weeks of planning and going to take up my entire weekend - in a good way - but not anymore. Instead, I went out with a few of the ladies last night and have booked myself a $40 90-minute massage thanks to Groupon. I'm leaving shortly, because if I can't be making a difference in the community, at least I can try to ease away some of my stress because that ain't good for the ol' cholesterol levels either.

Oh, and for anyone who's counting, I've lost 11.2 pounds so far. I'm trying to end on positive notes whenever possible, since they seem to be few and far between lately. So there ya go.

Twenty Days of Silence

My last blog post was 20 ago, and so much has happened since then. Well, OK, nothing exciting. But lots of little things. I will only write about three tonight. Deal with it.

I graduated physical therapy. After several appointments and consecutive days without pain, I had my final appointment. They didn't officially discharge me in case I need an additional appointment or two when I start running again, but I have no more scheduled appointments. As much as I enjoyed those 30-minute torture sessions, I'm happy to have a little more free time in my evenings and return to regular workouts. On that note...

Because I'm accident-prone, my therapist and I agreed it would be best for me to participate in their bridge program. Where I go to PT is actually a dance studio, a PT office, and a personal training center all under one roof. Therefore, I can start working with a personal trainer who has direct access to my PT records and my therapist, who is right there in case something starts bothering me during a session. And even better, my insurance covers $150 of the $200 fee which gets me eight 30-minute sessions or four 60-minute sessions. I opted for the eight, and my first session was supposed to be last Thursday...

Except last Thursday, I started feeling horrible. I didn't get to work until 10:30 because I felt so awful, and when I did arrive, I was soaked through my clothes in a cold sweat despite driving with the windows down in the 30-degree weather. Clearly I had a fever and had no business being at work. I wrapped up a project and left around noon, and proceeded to die for the next six days. I thought it was my 17th sinus infection, but it just kept getting worse. I had every symptom imaginable - sinus congestion/pressure, sore throat, runny nose, headache, fever, chills, fatigue, body aches, cough, no appetite. I spent the entire weekend in bed. But when I woke up on Monday, the pain was also in my chest and that worried me. So I made a doctor's appointment and fortunately it turned out to be from the coughing - my lungs were completely fine. She said I have the awful viral infection that's been going around and that antibiotics would be useless. I told to keep doing what I'd been doing - Sudafed, Mucinex, ibuprofen, cough drops, Vicks VapoRub, vaseline on my Rudolph nose, and lots of rest and fluids. I woke up this morning feeling like hell, but was finally able to get myself going.

I finally returned to work this morning at 10 (mornings are hard when you can't breathe for the first two hours after waking up). I had no itention of working the whole day but I started to feel a lot better as the day went on. I am now stuck with a runny nose, brutal post-nasal drip and thus a mucus-y cough, but otherwise feeling much much better. However, I originally rescheduled last Thursday's training session to tomorrow, but I don't want to end up sick again this weekend, so I postponed it until next Thursday. Let's hope nothing comes up then!

I normally feel really guilty when I miss work, but not this time. This is the sickest I have been in a long time, and I knew I needed to take care of myself. I can work through a cold or when I'm really tired, but this was a lot worse than that. It doesn't help that everyone has been really negative at work lately, so I honestly didn't want to go back. But I did want to feel better, so there ya have it. I am so looking forward to a four-day weekend this week. Thank you, Easter Bunny!

Speaking of the Easter Bunny, I gave up meatless Lent 10 days early. Yup. I don't give something up for Lent because I'm a practicing Catholic (I'm not anymore). I give something up because I like to test my discipline  And well, five weeks of no meat was long enough. On the first day I ate meat, I had antipasto salad and buffalo chicken. The next day, I had a gourmet cheeseburger. And the rest is history. I still don't eat meat every day (I follow meatless Mondays), and I usually eat salad for lunch, either with tuna or no meat, and I'm usually so tired by dinner I eat something small. So it's not like my carnivorousness (carnivorism?) is out of control. I just got sick of not eating meat when I like eating it, and usually make healthy meat choices. I can't wait to indulge in some bacon this weekend.

Skinnier Shins

I'm in my fifth week of physical therapy for my shin splints. They are getting better, but my therapist says the progress is slow. He tried a new taping method last night, and my legs feel pain-free for the first time in about two months, so that's awesome!

I should probably back up a little bit. When I went to Texas, I didn't work out at all. Bad Kelly! We walked a lot and I ate surprisingly well, and managed to lose half a pound. But when I got back, I did one Jillian Michaels Body Revolution workout and haven't done one since. I rode the bike once (10 miles, go me) but then exhaustion set in. I ended up feeling quite sick this past weekend and decided to listen to my body. I still ate really well and managed to walk a few miles every day with Rags, but did no weight lifting or real working out. But then something magical happened–I realized my shins felt better. So I decided to continue letting them heal, knowing that I was basically sabotaging my weight loss efforts. But at some point, you have to choose between losing weight and healing an injury. I still kept to my healthy diet and walked, and as of this morning I am down a total of 8.6 pounds–1.6 pounds since I left for Texas. So the plan is to continue to do only walking and stretching until we start seeing some major improvement in my shins.

This is what Treavor's new taping method looks like. It's on both shins. I'm also wearing these new Zensah compression sleeves almost 24 hours a day, which are helping immensely. I felt so good after leaving physical therapy last night that I went gentle yoga. It was exactly what my body, mind, and spirit needed. I'm going again tonight (as long as classes aren't canceled due to the snow), Friday, and Saturday...and hopefully every day until I can get back to my regular exercise regimen.

I signed up for a 5K this past Saturday, not realizing A. it was the day Mom and I had tickets for a gymnastics competition in Worcester and B. that I would still be forbidden from running. So I'm really hoping these babies hurry up and heal because I want to sign up for this 5K instead. It's actually being held in memory of the former and late athletic trainer from Longmeadow High School–Pete Krasnor–who taped me every single day for four years, and helped me through at least three major injuries (a broken finger, a broken ankle, and a horribly sprained ankle). He was special to me, but I know that there are hundreds of high school athletes around western Massachusetts who would say the same thing. So it's a personal goal but it's also a personal mission.

Good News, Bad News

The past few days have been filled with highs and lows, ups and downs, good and bad.

I was headed to Dallas to spend three days at a Junior League national training conference, called the Organizational Development Institute.

Good news: I squeezed in a workout before I left for the airport, and hit no traffic during the entire 90-minute drive.
Bad news: I was really early to the airport, and while on the shuttle from the parking garage, I learned my flight was delayed 90 minutes, so now I am really early.

Good news: I found a place in the airport to get food, charge my electronics, and order a 9-ounce glass of wine to kill time.
Bad news: That 9-ounce glass of wine cost me $16 and someone decided to turn on the AC.

Good news: After three hours of delays, we finally boarded the plane.
Bad news: The pilot came on the loudspeaker to tell us the storms in the Midwest and the headwinds were working against us. What is normally a four-hour flight was going to take five or longer.

Good news: The movies on the flight were free instead of $5, and there was actually one I hadn't seen yet (Chasing Mavericks).
Bad news: I couldn't sleep at all. Or read. The turbulence was way too rough for either.

Good news: Even though I arrived much later than planned, my good friend from grad school - Christina - still met me for dinner at my hotel.
Bad news: She had to sit in the hotel lobby and wait two full hours for me to get there.

Good news: I got a room on the top floor - club status, baby!
Bad news: My bed had a divot from multiple bodies laying (hopefully alive) in the same place where I like to sleep. My sink continuously dripped, and my toilet never stopped running because there was a leak in the tank.

Good news: Room service was the same price as the buffet breakfast downstairs, so I ordered room service for the first time in my life!
Bad news: They forgot my potatoes and toast, and gave me cream when I asked for skim milk.
Good news: They sent someone up with my potatoes and toast. I had milk in my fridge that I brought from home (relax, it's shelf-stable).
Bad news: They forgot butter for the toast.

Good news: Breakfast the following day was included in the conference.
Bad news: "Breakfast" meant fruit, pastries, coffee, and juice. No protein in sight.

Good news: We got morning and afternoon refreshment breaks throughout the conference.
Bad news: The "refreshments" were coffee and tea.

Good news: My flight home was far less eventful with no delays.
Bad news: We had to circle Logan for almost an hour because of the snow in Boston.

Good news: My suitcase was one of the first onto the baggage claim and the shuttle to the parking lot came quickly.
Bad news: I had to clear several inches of icy snow off my car since I parked on the top level of the garage.

Good news: There was no traffic on the roads from Boston to Woburn (I stayed with Julia since it was late).
Bad news: the backroads were so bad that I spun out and nearly missed a stone wall, and then continued to slide down a hill sideways.
Good news: I avoided the wall (by about 3 inches) and no one was coming as I slide into what would have been oncoming traffic.

Good news: I drank many glasses of wine over the course of my trip, ate every meal in a restaurant, and never worked out (except walking around) and still managed to lose a few ounces.
Bad news: I had to stop my workout DVD after 20 minutes today. I was so winded and my fascia were on fire.

Bad news: I didn't get to see much of Dallas except for my hotel (Sheraton North) and the Galleria/Westin.
Good news: I did manage to cross something off my bucket list - dancing with a cowboy at a honky tonk in Texas! Several cowboys! Hot cowboys!

Bad news: We cried a lot this weekend. Some parts were really raw and emotional, and the girls from Ft. Myers and I shared a lot we may not have otherwise.
Good news: The girls from Ft. Myers and I bonded so much. I learned something about each of them that I didn't know before, and probably never would have had we not been far from home with only each other. I made some great new friends, learned a ton, and can't wait to visit Dallas again. And Ft. Myers!

Seriously Thyroid?

I had my annual physical yesterday. I actually didn't have one in 2012 because I got a job in Massachusetts and moved much earlier than I originally planned, and then when I got here, I had to go a month without insurance. Then I was trying to play catchup with my specialists and just completely forgot to get a physical.

First things first, I'm hypothyroid...again! My TSH is back up to 6. So we have to increase my Synthroid. Shocking. This may explain why I lost 7lbs in my first week of Jillian Michaels Body Revolution but haven't lost an ounce since then.

Secondly, my cholesterol is still through the roof. When I was diagnosed with Graves' disease, I spent a few days in the hospital. They ran every test under the sun, including a lipids panel. My total cholesterol was around 150. One year later, after being on propylthiouracil (PTU - an antithyroid drug) and propranolol (a beta blocker to lower my heart rate) for 12 months, my total cholesterol had doubled to 294. My physician assured me this was because of the beta blocker, since I was eating relatively healthy and had just started exercising again once my heart recovered from the initial thyroid storm. He told me not to worry about it, and my endocrinologist echoed that sentiment.

As of this week, my total cholesterol went up even further to 301. What?! This makes no sense. I spent the entire summer riding my bike every day and going to yoga, spent the fall eating like a bird because I was recovering from surgery and couldn't exercise much, and have spent the winter thus far exercising like a mad woman and eating insanely clean, staying at a strict calorie limit and not eating back calories burned. I have not once gone over the recommended 300mg of cholesterol per day, and rarely come even close to that. My mom's side of the family all has high cholesterol, but a lot of them are overweight and never exercise, so I'm not willing to blame it on genetics because I do exercise and I am getting my weight under control, slowly but surely.

The breakdown is:
Triglycerides 130 normal
HDL (good cholesterol) 72.5 high - which is good!
LDL (bad cholesterol) 202 very high - which is very bad!

The fact that my triglycerides are normal is suspect to me. My new/old (2003-2007, and 2012-present) physician wants me to cut my beta blocker dose in half. I have been asking to ween off this drug for a year but neither my endocrinologist nor my cardiologist were willing to help me do this since my resting heart rate was still pretty high. She says she has never seen such high cholesterol in a healthy, active 28-year-old. Gee, that makes me feel awesome. My brother nailed it on the head when he said, "That must be disheartening. You've been working so hard and eating well." No s&*%. Ugh.

We'll be repeating both the thyroid tests and lipid panel in eight weeks. I am on a strict low cholesterol diet until then (even though I was already watching my cholesterol intake) and am going to do as much as I can to get that LDL down - adding ground flaxseed to every meal possible including the oatmeal I already eat every morning with my breakfast, using only olive oil instead of butter, not making baking any sweets I might be tempted to eat, and keeping up with my six-day-a-week exercise program. Lent couldn't have come at a better time because fish and nuts help lower LDL and I've added a lot more of that to my diet to make up for the meat and poultry I've given up until Easter. All of these changes plus cutting my propranolol dose in half had better help or else I'm going to end up going on a statin at the ripe old age of 28.

Basically, all of my health problems right now can be attributed to Graves' disease. I wouldn't be overweight from six months on prednisone and constantly fluctuating hormone levels, I wouldn't have needed eye surgery for thyroid eye disease, I wouldn't have shin splints likely caused by being overweight, and I wouldn't have high cholesterol caused by a drug I need to keep my heart safe.

Because I was feeling so sorry for myself after getting my results, I went straight to the McDonald's drive-thru and got myself a shamrock shake. And since I had my last tetanus shot in 1998 and was long overdue, I had to get my Tdap yesterday, which kicked my butt. I spent the entire evening in bed watching TV because I felt so emotionally dejected, physically rundown, and my arm hurt like a motherf&$%#@. It still does, but I already did my workout for the day and survived.

Onward.

Face It, You're not a Runner...Yet

When I tried to become a runner over the summer, it ended poorly. After a few attempts, I was in excruciating pain with shin splints so bad that it hurt to walk around my office in flats for weeks afterward. So I gave up.

This winter - of all times - I decided to try again. I started slowly and actually used the 5K Runner app on my iPhone. I tried a few apps, but this one gives you audible cues even when your screen is locked, which many others didn't do. However, after the few few days, my shins were on fire again and I had to take an entire week off. I started up again, and ran through the pain, but knew something wasn't right.

It wasn't your typical shin pain. It was actually the insides of my shins on both legs. It hurt for 24+ hours after running, and flared back up whenever I did the cardio days of Jillian Michaels Body Revolution.

So I called up my old orthopedic surgeon who performed my knee surgery back in 2005, and he agreed to see me even though he is semi-retired and no longer operates. The first thing he did was order X-rays of my legs. Fortunately, no stress fractures. However, he said it was definitely shin splints and recommended 600mg of ibuprofen three times a day and physical therapy. Well, remember kids, I am prone to ulcers. I had one as recently as spring 2011 and had to stop taking all NSAIDs for six months. When I forgot and took them for my severe thyroid eye disease pain, my stomach burned for a week - hello again, ulcer! So, I decided I won't be taking 1,800mg of ibuprofen every day. I instead take 400mg when I really need it after running.

I did agree to physical therapy, even though that seemed a little silly for some shin splints. Boy, was I wrong.

I went to my first appointment Monday night, dressed like I was going to the gym. I am no stranger to PT, but it has been about eight years since I last went, and that was for knee surgery rehab. Shin splint PT is a whole other beast. I know all about deep tissue "massage" and how unpleasant it is, but I was not aware of the Graston technique until last night. Let's just call it torture, shall we?

Backing up, the physical therapist first asked me about my symptoms. She looked at my arches and gait, and determined that I have low arches and am nearly flat-footed. She recommended I get orthotics for my running shoes and cross trainers, and interestingly enough, it is the same orthotic I was planning on buying anyway. She told me she was going to do the deep tissue massage, and I knew that wasn't going to be fun. But then she brought over these metal tools that reminded me of the mixing blade on my stand mixer and a barber's blade, and I was suddenly very afraid. She explained these Graston tools help break up scar tissue and increase blood flow. She also explained that one's shins should be smooth under the skin. For as long as I can remember, mine have been bumpy. But since I was a competitive cheerleader and never a runner, I never realized how damaged my shins actually were. I laid there biting my sleeve and practicing lamaze breathing while she worked on each shin for several minutes. The pain was unreal, but as soon as she finished, she had me stand. I felt immediate relief - a feeling I haven't had in months.

She also told me that the cause of my shin splints is twofold: weak lower legs (calves, ankles) and my low arches. The orthotics will help my arches while stretching and strengthening my calves will help my lower legs. My ankles are permanently shot from spraining both multiple times, breaking the right once, and tearing all the ligaments in the left once. They basically flop in ways any joint should not. So we have to focus on strengthening my calves, which used to be my favorite muscle to show off. I remember going to a dance my junior year and having my date and all his friends ask me to show my calves. I could rise up on my toes and this huge muscle would shoot out my otherwise skinny legs. It was impressive and intimating, but now my calves are just fat. So fat I can't wear boots higher than my ankles, and that bums me out. So hopefully these new stretches combined with my diet and exercise will help my shins and my ability to wear cute boots!

After the torture and stretching, she iced me down for about 15 minutes. That felt OK, but my ankles really started to hurt from being at a 90-degree angle when they normally relax at about 170 degrees (gross, I know). Picture a gymnast's feet during her routine - her ankles are about 180 degrees. Now picture her standing on the medal podium - her ankles are at 90 degrees. My ankles naturally fall to 170 degrees or so on their own because they are so damaged, and probably trained from years of pointing my toes. So when they are forced to 90 degrees, they fight back. They still hurt now.

Finally, she taped me using the same exact Kinesio tape I bought online, but had no idea how to apply. It is quite simple, actually. And I can wear the tape for a few days, even in the shower. And yes, I manipulated the colors in this photo because I'm ashamed of how pasty and white I am. But regardless, the tape helped so much throughout the day.

Before I left PT, she asked, "If I tell you to stop running, will you listen to me?" I agreed, but insisted on being allowed to continue my other workouts which include two cardio-only days and four days of either just strength or strength and cardio (depending on my mood and schedule). She OK'd this.

I went to the orthotics store on Tuesday to buy what I thought was going to be support for my low arches. However, I had a foot assessment done and I don't have low arches at all! I have medium-to-high arches! I thought so! The assessment showed that I put almost all of my weight in the balls of my feet, which stresses the fascia and thus causes shin pain. After walking around the store with the orthotics in my shoes, I forked over $70 only to later find out the same orthotics are available online for $50. Annoying.

My workout Tuesday was far less painful. It was a strength day, but my feet felt really good, and my shins were less sore than usual.

I went to physical therapy right after work on Wednesday. I had a different therapist, but we started with 15 minutes of heat, Graston (which hurt much worse than it did Monday, and also much worse on my right shin than the left), massage, and stretching. It took all of 35 minutes, which was nice. I got home and did my cardio workout. By "did" I mean "attempted." My feet were hating the orthotics. Tuesday involved very little jumping or running, but Wednesday was ALL jumping, running in place, and a few boxing moves. The program is only 24 minutes but it took me almost 40 because I had to keep stopping. My shins were sore but my feet were actually breaking inside my shoes - or so I thought. The orthotics have metatarsal support and my feet simply aren't used to that yet, so they revolted. Ow. I made sure to ice my fascia as well as my shins afterward, but I was limping by bedtime.

Fortunately, I woke up feeling fine. It's just an adjustment period. I'm about to head to the campus fitness center (free for employees) to do my C25K training on the treadmill since I promised not to run on pavement. If it hurts my shins, I will stop and switch to the bike or elliptical. And then when I get home, it's a strength day, so hopefully my feet and shins can recover.

I'm not a runner...yet. But I have big hopes of running a 5K this spring, so I'm doing what I've got to do to get there.