Confusion - you just won't believe me.....

From time to time I like to roll out Auntie Margaret's disco ball so you can have a jolly soundtrack while reading this blog.

Confusion - New Order

I hope you will enjoy New Order's Confusion. It's a tune from my youth, rather stuck in my head at the moment, read on and you will find out why.....

The NHS changed on 1st April 2013. I went to a conference last year where I found out quite a bit about the vision and commitment behind the changes and actually came away feeling cautiously optimistic. I could see the strong desire to become more patient focussed. There were a lot of fine words. The new NHS Constitution really makes a lot of sense.

My concern was that NHS resources are so stretched, the system so Byzantine and the changes being pushed through at such a fast pace that it may prove very difficult to realise the ideals supposedly being pursued. Also, my natural suspicion of politicians' motives made me wonder whether actually the whole restructure project is really in service of a totally different agenda - basically the dismantling of our NHS by creating something so totally unworkable that staff and patients will simply exit the system in ever increasing numbers. Is it really possible that our government could be so cynical they would actively seek to destroy this wonderful institution which we all care about so passionately and which has so much going for it? My optimistic soul hopes fervently this cannot be the case.  But you know, sometimes I can't help but wonder.

So what is going on? Total and utter bloody confusion on one hand. Some very determined, intelligent, committed individuals trying to do something really good on the other.

I went to another meeting yesterday - the board meeting of the governing body of my newly created local clinical commissioning group (CCG). It was open to the public, in the spirit of transparency and welcoming patient voices. It was interesting and yet again I came away feeling cautiously optimistic.

I was quite excited to meet a chap on the board who's a professor of endocrinology and was very encouraging about the British Thyroid Foundation getting more involved in lobbying CCGs around the country to improve standards  and consistency of care for thyroid patients. He even indicated there  may be some funding available to help the charity do this. He said that GPs should have greater access to specialist knowledge to help their hard to treat thyroid patients, under the new structure. And he kindly offered to send me some documentation that will help me understand where things are going, with (I'm  hoping) the potential for the charity to influence things going forward.

(I hear on the grapevine that BTF will soon be launching a three year Hypothyroidism Care Strategy, more on this in future posts....)

He and all the other CCG governing board members who were there appeared to be bright as hell, highly motivated and very much focused on  improving patient care, listening to patients and effective resource management in order to provide the best possible quality of integrated care. Impressive.

Rewind to the real world - a month ago I asked my GP to find out why my endocrinologist had sent me a blood test form which was a duplicate of one I already have which he had previously told me to use before my next appointment with him (due in about 5 months time).  It had arrived via the post with no accompanying note so I don't know if I have it in order for him to monitor me between appointments, perhaps depending on how I feel ( that would make sense)  or if it's just a duplicate been sent in error (perhaps more likely). A month later I chase for a response because I have a sneaking suspicion I should possibly be having the test fairly soon, particularly as I still don't feel quite right (about 6 weeks after my last test), the receptionist confirms that the GP sent a letter to the endo the day I spoke to her but no response has come back. Apparently the letter was sent via COURIER.

The last time I tried to ask a question of my endo I had gone direct to his secretary (naively assuming that was the best way to contact him) and had quite a weird experience as she ended up telling me to reduce my medicine without seeming to take his advice on the matter and I ended up (a few months later) quite unwell because the dose reduction was too much. It was a bit of a complicated scenario. I was feeling over medicated so thought a reduction was the right thing to do and after trying and trying to get the docs view on it I finally gave in and just did as I was told by his secretary, she basically capitulating to what I was saying I thought I probably needed to do. Subsequently (many months later when I saw him and by which time I was proper hypo again) the endo said he would have advised a more subtle adjustment.  Not good really is it? He also told me if I had any questions in the future I must go via my GP as she would be able to get an answer by going through the correct channels.

Anyway - the learned professor, at the forefront of the brave new NHS, with all it's efficiencies and openness and patient-centric approach,  had told me that GPs can now access information from specialists via the Choose and Book system. Apparently it's not just for booking appointments, it's also a communications channel that should enhance the quality of the care we patients get. The key to quality care for thyroid patients, according to the Prof (and I agree) is GPs listening to symptoms, not just looking at blood test results - and conveying quality information about those symptoms to specialists, who can advise them on what tests to order/treatment to try, if they are unsure themselves what to do. The key to success is quality information.

My GP's surgery have never heard of Choose and Book being used in this way. Perhaps it's a new thing coming in and has not actually started yet. Anyway. The fact is that last September because I was unable to access specialist advice I started taking a lower dose of meds than I should and by March this year I was very unwell again. And I am still not as well as I was before so I still want some specialist support for what to do, or not to do about it and my GP has been unable to get a simple to answer to a simple question of whether or not I am supposed to get my blood tested for over a month.  The chances of there being any transfer whatsoever of quality information relating to the actual symptoms I am experiencing being relayed to my endocrinologist seem remote. the last time I saw my GP she appeared so dismissive and almost hostile seeming, with no interest whatsoever in hearing about any of my symptoms I am almost at a loss to know how I should approach her to try and get her on side and helping me work out what I should be doing now.

And I'm so mystified about why she seems this way because I honestly think she's mostly a good doctor and very conscientious - she sent the query to the endo the same day I saw her. I know she works long hours and takes a lot of time with many of  her patients, she obviously cares about her job and often gets rave reviews.  I don't know if there's something about the way I present in surgery that gets her back up. I try not to be a nuisance but at the same time I am probably a bit more challenging as a patient than perhaps she's used to. I ask questions, I have opinions, sometimes I get tearful, usually when my thyroid hormones are out of kilter.  I don't know. I appreciate that the long hours she works just might mean she sometimes feels under pressure and her communication style suffers as a result. I try to be understanding of that.  I stick to the facts and do my best not to get emotional. But it's hard, being ill. I wish the system was a little bit more supportive of that than it sometimes seems to be.

So today I'm confused. thank heavens for early '80s classic pop, always a comfort in times of uncertainty. :)

How are things with you, what do you think of the NHS changes? What's your experience been recently of navigating the system? What do you think of the latest offering from Auntie Margaret's disco ball?

In solidarity.

Thyroid Hope.

Breaking news about thyroid disease

Today's prompt for Health Blog Post Month (#nhbpm) is to write a news style post, here goes:

Read all about it! 

This Saturday, 10th November, leading endocrinologist Stephen Robinson, will give a talk on the issues around pregnancy and thyroid disease at the Royal Free Hospital in Hampstead.*

The meeting is organised by The British Thyroid Foundation (BTF), a tiny charity with a massive challenge..  

Many families are directly affected by thyroid disease. It is very common - one in 20 of us in the UK have a thyroid disorder - yet they will have seen little in the media about it.  It is largely a hidden disease though in some cases has a devastating impact on people’s lives and can lead to miscarriage or pre-eclampsia if not properly treated in pregnancy. 

Anyone wishing to attend this meeting should contact Lorraine Williams to book a place. 

High profile thyroid patients have included the popular writers and broadcaster Clare Balding and boy wonder of the 2012 London Paralympics, Josef Craig.

The thyroid gland in your neck produces hormones for the cells in your body to work normally. When it goes wrong it can have wide-ranging effects.  Up to 20% of patients have symptoms that prove difficult to resolve.  Thyroid disorders can run in families; they tend to occur mainly in women, but anybody - men, teenagers, children and babies - can be affected. 

While often these disorders are easily managed, this is not always the case and many specialists agree there is still a great deal more we need to know about the thyroid and how it works.

Recent research has highlighted the very real hardship and distress that can be caused by thyroid disease, yet many doctors admit they are not as sufficiently well-informed as they need to be to fully help their patients. The internet can be full of rogue information and scare mongering about thyroid disease which can lead to confusion and distress among those affected.

Raising awareness about thyroid disease and supporting patients is vital. Most people would benefit from being better informed and prepared to deal with thyroid disease, should it happen to them or someone they are close to. 

Set up 21 years ago and still operating from a tiny office in Harrogate, North Yorkshire, heavily reliant on a team of volunteers around the country, BTF operates on a shoestring budget.  The charity desperately needs more funding to grow; to support the increasing numbers of thyroid patients who contact them, by providing information about their illness they often cannot find anywhere else, and to help fund more research into thyroid disease.

BTF works closely with the medical profession and other organisations[1], funding and supporting crucial research projects, doing their best to influence medical practice on thyroid disorders, ensuring patients’ voices are heard and creating a strong nationwide volunteer network.  But more needs to be done to meet the growing need from patients for information, support and advocacy, as well as to provide more funding and support for further research.

To find our more, or to make a donation click here to visit the BTF's website. 

*For details of how to register for Saturday's event click here

---

[1] BTF is a National Institute for Health Research (NIHR) partner organisation and collaborates with the following: British Thyroid Association (BTA), Society for Endocrinology (SfE), Association for Multiple Endocrine Neoplasia Disorders (AMEND), Butterfly Thyroid Cancer Trust, Cancer 52, Thyroid Eye Disease Charitable Trust (TEDct), Thyroid Eye Disease Amsterdam Declaration Implementation Group UK (TEAMeD), Addison’s Disease Self-Help Group (ADSHG), Hypoparathyroidism UK, and Sense about Science.

Thyroid talks

I've spent the last few days looking for a speaker for our next British Thyroid Foundation information event in London (3rd March). Last year we asked attendees what topics they would like us to cover in the future.

Here are the results of our poll:

What topics would you like to see covered in future events?

How get the most out of your doctor when you have a thyroid disorder – including power questions you can use, 19 votes

Nutrition and thyroid disorders – listening to and knowing your body, 16 votes

Mental health and thyroid disorders, 13 votes

Thyroid disease and bones (confirmed topic for 15th October event), 9 votes

Patients sharing their stories, 6 votes

Thyroid facts and fables, 6 votes

NDT (natural dessicated thyroid) research, facts, fiction, why do the USA use it and not us?, 5 votes

Thyroid disease and pregnancy, 3 votes

Thyroid Surgery, 3 votes

Thyroid Cancer, 2 votes

Radiology, imaging and the thyroid – radiology and imaging innovations are at the cutting edge of medical research, 1 vote

So, in response to this poll, we were looking for a speaker to cover the most voted for subject: how to get the most out of your doctor.

We also wanted to get someone to talk about cognitive behavioural therapies and techniques  (CBT) that thyroid patients can use to help us manage our conditions. We felt the two topics could potentially sit well together.

Suprisingly, while there are specialists who use CBT to support patients with chronic illnesses there doesn't seem to be anyone who is a thyroid specialist doing work in this area or focusing on thyroid and mental health issues. Not that I've been able to find so far anyway.

I speak to quite a lot of thyroid patients these days and so many of us share the experience of struggling with our memory, sometimes our emotions and often our ability to think clearly. A lot of people are very concerned about these symptoms and often they don't know that they are not alone in experiencing them. Just knowing that other people have similar experiences is in itself enormously reassuring for many people.

I've heard an endocrinologist say that he and his colleagues see thyroid patients as a "difficult bunch" because they can be over emotional and snappy in consutations.

Frankly I'm surprised that there isn't more medial support for this aspect of the illness. 

I left my last job because my brain just wasn't working the way I needed any more, to be able to continue to function in a demanding work environment. More than twenty years of building a career that was important to me has kind of gone down the drain. I'm lucky, my adorable husband is able to support me and I've regained sufficient mental capacity to be able to now do some  interesting paid work again on a freelance basis. I don't have children so when I'm tired or feeling foggy I can just rest.

I'm incredibly lucky. But there are people out there who are not so lucky, who are seriously impoverished and in many cases desperately unhappy as a result of not being able to work because they can't think straight and / or don't have the required stamina.

Personally, as well as being in good circumstances (which I'd just like to point out I have created for myself I wasn't born with any silver spoon in my mouth, far from it), I've found that I have been able to help myself a lot by practising cognitive behavioural techniques. Being aware of how my mind works and the impact of what I'm thinking and doing on my wellbeing, thinking and acting mindfully. Eating well, exercising, getting fresh air, not dwelling on anything that upsets me too much (because I've learned how exhausting that is!).

Like anyone else with a health condition I'm highly sensitised to the suggestion that my symptoms, particularly fatigue, could be caused by my mind. It's an outrageous and offensive suggestion and doctors need to learn to be super careful about how they broach the subject of the mind body connection. However I recognise that I am both a mind and a body and I've seen powerful demonstrations of how the two elements are bound together and can have extraordinary impacts on each other. I like the idea that I can help myself in some ways and I understand that my body is a complicated entity with potentially more than one cause and more than one possible solution when problems arise. So I'm open to this stuff.

Lots of people aren't though. Mental health issues and labels are scary. People are afraid of talking, doubt that it can help them, see it as a diversionary tactic by the  medical profession. Understandably in many cases, following years of misdiagnosis and mistreatment, some thyroid patients are highly suspicious of the medical establishment. This is so wrong!

We need doctors to be able to help us.  We need acknowledgement that our illness can affect our mental capacity and we need advice on how to handle this and what we can expect with optimal treatment. And we deserve the best possible treatment to return us to the best possible state of health so we can be contributing members of society and not have to live our lives on the sidelines.

We don't want much!

It seems that research and specialist treatment in this area is very limited.

I'd love to hear from doctors who treat patients with thyroid disease. Do you find thyroid patients difficult sometimes? Do you consider that their illness could be making it difficult for them to communicate effectively with you? What do you think patients could be doing to help themselves get more out of their consultations with you and your colleagues. What are the best questions you've ever been asked by a patient and why was it so effective? What do you think is the best way to address the mental health and cognitive function aspects of thyroid disease, or is it something you basically ignore and don't see as relevant?

And I'd love to hear from patients, what do you think of this topic and what else would you be interested in learning more about, in relation to your thyroid disorder? If you're in London you can come to our information events and help shape the programme by saying what interests you, shall I set up a poll?

Thanks for reading, I'll let you know next time who I've booked as a speaker for Marchy. As long as we have breath we have hope.

:)

Shifting sands

I’m now in my new house by the sea and loving it. We moved at the end of October. I’m so excited to be here and everything appears to have gone pretty smoothly. But I must admit the move has taken it out of me a bit; that and the fact that I am now working, on a freelance basis, for two different clients, so work has gotten a whole lot busier. I’m pretty tired at the moment.

Mindful that it’s winter again and the last two winters my health went rapidly downhill. Wondering if there’s something up with my Vitamin D levels again, I went to my new GP to ask her to test it which she was happy to do but the results may take up to a month to come back!! That’s living outside London for you. So I’m unsure whether to just up my Vit D dose by myself in the meantime, in the hope it might do me some good, after all it’s just a supplement from the health food store I don’t think I’m likely to do myself any harm, or hang on and find out what the test says.  I want to do things properly and wait for a steer from my doc...

Also torn between changing to an endocrinologist close to home, which is an option, or to stick with the one(s) I see in London. The clinic in London is pretty shambolic, (patients waiting to be seen sitting on the floor / blood test and follow up letter mix-ups, not good really) and I generally see a different registrar each time I go there. But I know them now and they know me. I have a lot of anxiety about moving doctors in case the new ones don’t agree with the regime I’m on and I end up worse off. I’m also totally unsure about whether what I’m on is actually the right thing for me. It’s tricky, there seems so much controversy around thyroid treatment and here I am, over two years after diagnosis and still not wholly well, not knowing if there’s something else that could be tried that might make a big difference for me, I really don’t know what to do for the best...

Oh and my blog is under attack from spammers promoting desiccated thyroid supplements and like most thyroid patient who ever go digging around online for help for their condition and end up bombarded with people pushing this stuff, I do wonder a tiny bit whether that might be something worth trying.  If you see a two line comment with a link to an online shop in any of the comments on here, before I spot it and delete it, please be aware that this is the standard format for these spammers and is just someone trying to sell us all something. Bah, bad spammers, go away!

I spent yesterday talking to some endocrinologists as I was volunteering at the British Thyroid Association’s annual meeting, manning an information stand for the British Thyroid Foundation. 

Happy smiling volunteers on the information table at the BTA Meeting 2011, l-r: Judith Taylor - BTF Editor and Trustee, me - for BTF London Team and Lin Welch - from Thyroid Eye Disease Charitable Trust

They are a friendly bunch, the BTA people and no-one was trying to push anything on me but a couple of them were questioning my treatment to date and they have really got me thinking.

I mentioned in my last post that Professor Graham Williams’ talk at our last London meeting had challenged some of what I thought I knew about thyroid hormones.

I haven’t posted in detail about his talk because with the house move and work stuff I just haven’t had the chance to write it up, yet.

The key thing that he was saying that really got my mind working was that he would NEVER prescribe T3 for hypothyroidism. I am one of those people who takes T3 as well as T4 (click here for more info if you have no idea what T3 or T4 are). The official UK guidelines on treating people state that T3 can only be prescribed by an endocrinologist. I thought that was just because it’s a volatile substance and needs to be managed by a specialist, some GPs apparently were over prescribing it and this can cause bone and heart problems, hence the guidelines.

But Graham’s position, as I understood it, (and he is a world class expert) is that most T3 used by the body is converted in the organs, rather than in the blood stream, and those organs can only use T3 that they have converted themselves, from T4 in the blood, as they only have specific T4 receptors, so having extra T3 in the bloodstream (via meds) is probably not going to have a positive impact on wellbeing.  This despite my experience and belief that it has made a difference for me. 

Plus which, he made a very compelling case for the danger to the skeleton of thyroid hormones being out of kilter. He showed us photographs of healthy bones and bones that are weakened by both hyper and hypo thyroid states.  It wasn’t pretty.

So I said to him, back in October, how would you have treated me then? I was topped up to the max with thyroxine (T4), TSH as low as you’d want it, T4 right at the top of the scale, but I still felt rotten. He said he would have looked for other causes, such as vitamin D deficiency. Well lo and behold, about 8 months after I was started on T3 meds I was also diagnosed with that and lo and behold again, starting Vit D supplements appeared to have as profound an effect on me as the T3, perhaps more!

So now I’m wondering if the Vit D on its own might have sorted me out, with just the thyroxine. But I’m scared to consider coming off the T3 incase my brain goes back to being fuzzy mash it was before I was put on it and I then can’t get a doctor to agree to put me back on it!!

What to do??

Anyway, lots more discussion at the meeting yesterday has got me thinking even more. I will have to post again to share the rest. Sorry this post has got very medical. Let me know if you’ve been in a similar quandary and if you have any insights to share....

Ever hopeful, sending smiles.

Lorraine J

My guilty secret...

If you want to think I've got OCD after you read this you can think what you like, as it happens - I don't!

However, and I'm a little shy to reveal this, since I first realised that this illness was going to take a bit of time to sort out I have been faithfully completing a symptoms chart on a daily basis so I can keep track of whether I'm getting less fatigued, more energetic, more clearer headed, etc, over time....

Sometimes when I see my doctor I take along a copy of this chart to try and give my doctor more information about what is going on with me. Usually they quite like that. Of course different doctors can respond in different ways. I had one once who didn't like it at all and was actually quite rude to me. I didn't see her again!

After I got over the worst of the brain fog my chart became a spreadsheet, but originally, when I was first very ill and truly a small sorry fuzzy little thing with hardly no braincells at all that functioned terribly well, it was a very scribbledy hand drawn affair, because that was all I could manage to assemble.

product of my slow coach little brain cells back in 2010!

It was one of the things that made me realise my head was starting to clear when I was able to concentrate well enough to put all my precious symptom data (yes I am truly that sad!) onto a spreadsheet and make it a graph. The guy I see at the fatigue clinic tells me my graph is a work of art! All I want is for it to show some answers.

But the problem with the damn thing is that it never shows a nice clear positive upward curve to recovery. It always comes out as a jagged line, I get a bit better, I do a bit more, I get a bit more tired again, it goes up and down. Slowly over the long term I'm convinced I'm better. Those around me tell me I unquestionably am. But I look at the chart and it's kiind of difficult to read.

Excdel but my jaggedy graph - is still hard to read after the initial definite drop in fatigue!

I guess so much of how I'm feeling is subjective and what I might have scored as a '6' or a '3' six months ago is maybe not the same as what I'd come up with nowadays. Still it's frustrating. I wish it was all simpler.

I've just spent an hour updating my spreadsheet for the last 8 weeks since I saw my endocrinologist last. I've got an appointment tomorrow. I say "my endocrinologist" but actually I have no idea who I'll see because so far I haven't seen the same doctor more than once at the clinic I go to! That's how the NHS works. Weird and annoying. I would like to be able to see the same doctor and for them to get to know me a bit so they can see changes for themselves and for me to understand how they like to be communicated with and for the two of us to be able to collaborate a bit on me getting better.

I don't think I'm even going to take my graph tomorrow. I don't want whoever I see to think "we've got a right one here, crazy graph lady." I'm just going to tell them the facts as I see them about how I feel a bit better but I'm still not right and listen to what they have to say and hear what my latest blood tests results are and HOPE that the appointment will be useful and that there might be some kind of positive action that can be taken towards me continuing to feel better than I do now.  Could my meds be adjusted any more? Are there any other tests it could be worth doing? Is this as good as it's going to get? Do I just have to be patient for a while longer?

OOOghhch it's a slow old process.

I'll let you know how I get on. Sigh.

Shhhhhh, don’t say the STRESS word...!

I had a thought provoking session at the fatigue clinic yesterday, discussing stress. Have I told you that as well as seeing an endocrinologist I am now also attending this specialist clinic for fatigue?

It’s interesting. At the moment I spend an hour there each week doing cognitive behavioural therapy, that’s looking at how I think and behave with a view to improving my fatigue levels. I am highly resistant to the potential implication that my illness could be “all in the mind” but that’s not what they’re saying, just that everything is connected and there may be some mental patterns locked in my subconscious somewhere that might be perpetuating some of my symptoms. My thyroid blood tests are all now optimised and perhaps my health issues are not just down to my thyroid.  

Well I’m an open kind of a girl and up for discussing stuff....it’s good to have the chance to talk to a professional about what’s going on with me on a week to week basis.

We identified today that I am very resistant to the idea that I may be stressed.

I am fine with recognising that I have stress in my life and even that I have had very considerable stress in my life in the past. I accept that stress is normal and everyone has stress. If I am honest with myself I can even admit I’ve rather worn the stress from my childhood almost as a little badge of honour, “...look at me I had all that to deal with but haven’t I done well.”

But I know that I have quite a deep rooted emotional need to believe that everything is okay and under control in my world. It’s really difficult to accept that I am affected by stress or that I am stressed. I resist the idea of being stressed (as opposed to having stress, yet dealing with it admirably) as though it is a shameful label I don’t want anyone to put on me.

Of course there are times in my life when I know I have been stressed and I would admit that I was, but for the most part this is only the case when the stress I am under is very extreme.  For example; when I was waiting for my results of my finals at university I insisted I wasn’t stressed but I developed a rash over my entire torso. The results came in, the rash disappeared same day, go figure!

For the last four weeks, for my “homework” from the clinic, I have been tracking my stress levels. I have not as yet recognised that I have been more than very slightly stressed at any time.  Most of the time I believe I am not stressed because I am having a nice time, relaxing or doing fun things, which I am fortunate to be able to do because I am not working at the moment.

And yet, I have noticed that my muscles are tense most of the time and I have to accept that feeling tension in my muscles is most likely a manifestation of stress. So maybe I’m more stressed than I appreciate. ..

I would say that my life is not stressful at the moment, my life is delightful, I’m not working, I can do pretty much what I like with my days (obviously limited by my energy levels), I am not short of money (for which I feel exceptionally lucky), I am not short of social opportunities, I am loved and I know it.

However, I am in a kind of limbo land in relation to my health. I don’t have the energy to pursue many of the things I would like to do right now and I don’t know to what extent I may regain the energy levels and clarity of mind that I used to have, so I can’t really make plans for the future.

Perhaps I am more anxious about that I have admitted to myself. It doesn’t seem unreasonable to suppose this could be the case, when I stop and think about the situation I am in.

Hmmmmmmh. I’m not going to berate myself for the fact I may have been denying my true stress levels and the possible impact they may be having on my fatigue levels. Whatever I’ve been doing or thinking is neither good nor bad, right nor wrong, it’s just how things have been/how things are.

However, I believe that the more I can recognise and respond to reality, rather than my beliefs about how things ought to be, the more powerfully I am likely to be able to deal with it. And that includes the reality about my state of mind, as opposed to what I might like to tell myself about how I’m feeling.

Today I have realised that my level of stress may not just reveal itself in the thoughts I have, it can also surface in physical ways. And being someone who is mentally exceptionally “strong” it makes sense to me that if I am stressed my body might signal the fact before my mind picks up on it. So I’m going to be paying more attention to what my body may be trying to tell me in the next week.

Do you listen to your body? What does it tell you? What is your relationship with stress, do you pay attention to it and how do you know if the levels in your life are healthy or not?

I know this post is a departure from what I promised but I wanted to put these thoughts out there for discussion....as always I will be thrilled to get any comments...