Der Feuervogel aufersteht.

I spoke with the supervisor, who actually listened to my explanation of what happened and why I shouldn't owe any money. She talked to my doctor and called me back. My doctor is going to cancel out her charge from March 1 (making that the no-charge visit), meaning I won't owe them anything.

Finally.

+548, 14740/90000.

I got some writing in before lunch. Not the word quota I need to make Scrivener happy (660), but more than the 0 I was expecting.

I officially am the hardest IUD insertion my doctor has ever done. Apparently my cervix goes down before it goes up. But we have notes for next time in my chart, so hopefully it won't be as much of an ordeal.

I had a 3-month recheck of my levels earlier this month. My TSH is still too low, from my having been on way too high a T3 dose for a month or two, so my doc said to drop from 4x5mcg T3 per day to 3x5mcg. Starting about a week after decreasing the dose, I started to get more migraine-like symptoms and tinnitus. I got to a point where I couldn't stand it anymore, so I took 4x5 mcg one day. Unsurprisingly, I felt much better that day. (I've been tracking symptoms in the "mini diary" tool on my phone.)

Yesterday I did that again, and felt great. Today, there's massive sinus pressure and tinnitus making me want to stab my eardrums out.

I'd like to see my TSH in the normal range, but I hate feeling like this.

My T4 is borderline low, though, so maybe I could go up on my Synthroid and stay on 15 mcg of the T3. I should call my doctor's office, I guess. She wanted me to do another recheck in 8 weeks (so, the first week of October), but I'm not sure I can make it that long.

So, I called Duke Sports Medicine today and got an appointment for next Thursday. Fine.

I get the online checkin email and go to the site to go through it. Insurance is right, agree to pay for shit, hit the second to last page and find a box filled with $250 that I'm expected to pay, rather than the $30 copay that's in my benefits booklet.

Oh, it's a HOSPITAL-based service, and subject to my deductible before anything else. It had better fucking NOT be $250 each fucking time. Hospitals can choose whether to have outpatient clinics, and they can choose whether to bill insurance as facility-based (and get the patient's full deductible) or as a free-standing clinic and just get their copay. Of course they'll choose the higher bill. Profit über alles.

And the BCBS-NC website has no option to find a physical therapist in their "find a doctor" area. It's not an option on its own, and it's not under specialties, so I can't "shop around" as free market fellaters would have me do to find one that isn't hospital-based and thus only subject to my $30 copay.

Update: I called the clinic back to see if that would be an every-time thing or just this once, and the guy who answered didn't think that sounded quite right (like it hadn't been billed to insurance yet, which they do the day before the appointment), so he transferred me to the person who handles insurance, who was either away from her desk or on another line. I left a slightly rambly voicemail asking whether I'd be paying the deductible or a copay or if it'd be $250 every time or what.

Update 2: The person who handles insurance called back. I met my hospital deductible already (that sinus CT back in October, which was clean and bought me the neurologist referral), and I'll have to pay nothing for it (until fall, if I'm still going in, when I pay the $250 again). Because it's hospital-based, not clinic-based, I don't even have to pay the $30 copay. Which is better, I suppose, but still unexpected to see "yes, you will owe $250 for your appointment. Please pay $100 in advance, and you'll be responsible for the balance upon arrival." (There's an option to skip payment, which I did, because it sounded entirely wrong, and I figured I'd pay it when I got to the appointment if I had to.)

ObProSinglePayer: Because clearly, the government couldn't be any LESS efficient than having an entire department that deals with the ins and outs of the dozens of insurance providers and their dozens of plans.

I've been alternating a whole and a half Cytomel 25 mcg tablet for the last few weeks, and it's been going better. I think I'll ask about getting a prescription for 4x5 mcg tablets a day at my appointment in a couple weeks, because the half-tablet days are noticeably more symptomatic. Like right now, my ears are ringing, and they were fine yesterday, and I've got the slightest headache.

Cytomel has a 2.5-day half-life, which is fairly short. You reach steady state fairly quickly (2 weeks), but you also have more fluctuations in the levels throughout the dosing interval. So taking the same dose every day would be beneficial.

I go for fasting lab work on Friday. Cholesterol, blood chemistry, CBC, and thyroid levels. Yay. My white count may be a bit elevated, since I've had a cold for about a week. It's much better, and I feel mostly fine, except I have a stuffy nose and a productive cough. I've stopped sounding like a 90-year-old smoker, at least, though my voice isn't completely back to normal.

That's what it sounds like in my ears.

While I was on 50 mcg of liothyronine (T3), the tinnitus had abated and I felt pretty good overall. Then I started feeling off, saw my doctor, and the T3 blood levels came back high enough that my TSH was undetectable, so I went to half-tablets.

T3 has a 2.5-day half-life, which means it's gone from the system in about 2 weeks (5 half-lives), and that it takes 2 weeks to reach a new steady state concentration. Toward the middle of the 2 weeks after changing my dose, I felt better, and the tinnitus wasn't so bad. Since the two weeks have been up (about 4/7), I've felt worse, and the tinnitus is driving me NUTS. Also, my eyes are dry again, and my nose is bleeding. I wasn't having that problem on the higher dose of T3.

I've also noticed that my eyebrows are bleaching/falling out, which happened last summer when I had The Nausea, then got better with added T3. Wikipedia just told me that's an actual sign of hypothyroidism. Huh. I'm going to look through our vacation pictures from last summer.

So, my medico-scientific curiosity was piqued, and I decided to look up if there's any known link between hypothyroidism and tinnitus. Google turned up a bunch of less-than-reputable and woo-based sites, so I turned to PubMed, where I had it search for hypothyroidism AND tinnitus. It turned up 8 articles. This one is a case study of a woman who presented with both typical and atypical symptoms, and they mention tinnitus in the abstract. The full text does not appear to be online.

A very old article in an ENT journal found that the incidence of hearing/inner ear issues was correlated with severity of hypothyroidism. That one's full text *is* available online, but not for free, so I can't access it.

I'm also feeling more and more off as time progresses on this lower dose. More migrainish symptoms (facial tingling) and the actual migraine I had last week, for example. I can't concentrate on anything. I don't want to call my doctor's office today, because she doesn't work Wednesdays, and I'll end up having to speak to someone who doesn't have the full history again and get unsatisfactory answers (like "you should get your levels checked again 8 weeks after changing the dose." Well, I'm symptomatic, can we check my levels SOONER? But last week I wasn't convinced of being symptomatic; this week I am. So maybe I'll call again tomorrow. Eight weeks is still a month from now, though I have a pre-physical labs appointment 5/6, and if I don't go in soon, I'll ask to include T3, T4, and TSH in that panel.)

I don't want to be one of those patients, but this is having a very negative effect on both my quality of life and my ability to work.

1. Saturday, a few friends and I went on the Big Boss Brewery's tour for my birthday. It was extremely popular, but the weather was nice - 70 degrees or so - so after it was over, there was a big open-air festival almost in their parking lot. There were two food trucks (OnlyBurger (the veggie burger was pretty good, but the fries were meh) and KoKyuBBQ (Ben enjoyed the duck bratwurst sandwich and tater tots fried in duck fat)).

I tried their new Dunkelweizen, D'Icer, and it was pretty good. It wasn't Weihenstephaner or anything, but it was drinkable. (Speaking of Dunkelweizen, I tried New Belgium's in their Lips of Faith series; it was black as Coke and about half as sweet.)

After digesting the beers and food, Ben and I went out to Sage for dinner, where I boringly got the fesen joon. The jokey waiter must have cut his hair since New Year's, because I didn't recognize him until he started talking.

2. I haven't gotten anything productive done on my writing in a while. I fixed the plot issue I think; I still need to propagate some of the changes, but I can do that while I'm doing the hardest part of the revision process: getting into the characters' heads and adding descriptions. What do they see/hear/smell/feel/etc? What can I say other than "he narrowed his eyes" (eg)?

3. SCHEISST EUCH IN DIE HOSEN, WIR STEHEN GANZ AM OBEN, UND WIR STEIGEN WIEDER AUF. HIER KOMMT HERTHA! Yesterday's match pitted the best offense (us) against the best defense (Fürth), and we got a 2:0 win out of it, extending our lead over our next competitor to 4 points. Unless we lose the rest of our matches (which is, of course, technically possible, but not terribly likely), we'll get promoted back to the first league. HA HO HE!

4. I got the results from my bloodwork last week. I'm currently overmedicated for my thyroid, so I get to take half the Cytomel for a while and see what happens. (My TSH was undetectable, and my T3 was above normal limits, but T4 was fine.) Hopefully this won't lead to a return of The Nausea. Inability to concentrate is one of the symptoms of hyperthyroidism, so that helps explain #2.

5. Reading one of the free books I got, Darkship Thieves. I'm not very far into it yet, but so far, our heroine has ripped her nightshirt in half to stop the men attempting to abduct her in their tracks and commented on how she knows the man whose spaceship she ends up in is a "real man" (I paraphrase) because he responds to the sight of her breasts. Said real man (who's got cat's eyes, which is actually kind of nifty tech) is from an anarcho-individualist culture (barf), and on p 87, there's this bit about "those wacky 21st century folks, thinking there aren't really gender differences in brains" which made me want to hurl the book across the room.

Frustratingly, Persecution of the Other (and the people the cat-guy is descended from are basically bioengineered to be smarter/faster/stronger/fit better in X situation and were, of course, persecuted and wiped out on Earth, except those who fled) is very frequently a liberal/progressive motif, where The Other stands in for queers or racial/ethnic minorities or other real-life disprivileged groups. I don't get the impression Ms Hoyt has any truck with that librul pansy nonsense.

At least I didn't pay money for it. (I did buy Mark Van Name's omnibus Jump Gate Twist, and I feel OK about that, because Mark admits to being Baen's token liberal. Also, it features a beefcake/emo shot of Jon on the cover.)

6. Still taking tai chi. I'm taking a break from weapons to go back to Dr Jay's 9th Street Dance Chen class for the current session. I can't take both, because they meet at the same time. I may go back to weapons over summer, because it doesn't look like he's teaching Chen over summer. (I could be wrong; it happens on occasion.) I'm also taking Nina's Tuesday evening class, which may ALSO be going on hiatus over summer.

So I'm going to have to self-motivate if I want to get my yellow sash this year. I'm awful at that.

7. Cats are evil.

After 10 years of my dentist wanting me to get one, and 4 denied authorizations from Blue Cross, the note from my neurologist recommending a bite guard got the fuckers to do their job.

They wanted evidence one time that I grind my teeth. The broken teeth weren't enough? The fact that I have 4 crowns (which cost, each, twice as much as a bite guard) isn't enough? The visible wearing down of the points of my teeth isn't enough?

Free-market health insurance sure works great and manages costs effectively, doesn't it? Good to know that BCBSNC's logic goes like $650 < 4x$1300, so let's deny the $650 thing. Because that's sure cost-effective.

As I suspected: severe menstrual migraine with abdominal involvement. The neuro said I'm a "very interesting young woman," because my symptoms aren't necessarily bizarre, just ... an unusual constellation, I suppose. I wonder if it's "case report in JNeuro or Cephalalgia" interesting...

He's given me muscle relaxants for the massive tension from neck to hip (finally!) and he wants me to take a triptan daily for the time leading up to my period. He wrote for Frova, but Blue Cross wants prior auth for that (they prefer sumatriptan, Maxalt, or Relpax). So I left a message at their office saying unless there's a medical reason to use Frova (there might be; I recall it having a longer half-life or something), I'd prefer one of their preferred, so I can have a lower copay.

He sent me for a fuckton of labs -- by which I mean LabCorp just billed BCBS $2700. He's checking my estrogen level, sedimentation rates, some fancier thyroid function tests (T3, to see whether I need to add Cytomel to my Synthroid because I'm not converting T4 to T3 properly), uh... I forget, but they took 3 tiger-tops, 2 orange-tops, and a lavender. At least one of the tubes had to be frozen.

And he said I have to stop drinking daily caffeine, or at least try it and see if it makes my headaches stop (though the withdrawal headache will suck). Apparently, the type of neck tension I have can be related to and worsened by a caffeine habit. But I can still have it 2 days a week, so my Saturday morning Cup a Joe is not threatened. (At least I like herbal teas?)

I have a follow-up visit on 11/24. Ben, dear, what time do your parents get in?

First, a question: what sort of posts do y'all like reading? I don't get many comments, even to posts that I think might generate some controversy, or at least thoughtful discussion. I'm not trolling for comments, here; just wondering if I'm boring everyone to death.

Idea
I have an idea for a post based on something A said months ago, about the difference between liberals and libertarians. It's sort of the synthesis of his comment, some comments leora made on facebook, and months of my brain working on the whole thing. The words "monstrous" and "inhuman" may be involved.

Illness update
Tinnitus persists. Cognitive issues, like difficulty finding words, are also there. It's sort of like trying to think with a migraine, except without the icepick in the skull. I've slept poorly the last two nights. The eye doctor saw nothing in my eyes, so no eyestrain or vision changes or other signs of disease that are visible in the eye. I may have found a cyclical pattern that maps to my menstrual cycle, joy. Appointment with the headache clinic is in about a week. Should also be about a week till my period starts again.

Football
Hertha beat SpVgg Greuther Fürth 2:0 on Friday, making them the only undefeated team in the pro Bundesliga (1st and 2nd), and putting them nicely on the top of the league table with 23 points (7x3 wins, 1x2 draws). Only 25 matches to go this season, and if they keep this up, they'll be back in the 1st league next September. Unfortunately two of our top players were injured in the match. Nikita Rukavytsya strained a thigh muscle and is out for two weeks, and captain Andre Mijatovic will be out for six with a knee ligament injury (outer ligament, Außenband). They join usual goalie Maikel Aerts (ACL, at least four more weeks) on the injured bench. Coach Markus Babbel can put 17-year-old Nico Schulz in for Ruka, which he did a few weeks ago when he banned Ruka for coming late to practice, and he's got another option or two for Mijatovic. The other GK, Marco Sejna, has done well the last two matches, except for one spectacular fumble Friday that came dangerously close to a goal for Fürth. He's kept a clean sheet so far, and the Hertha defense has only conceded 5 goals in 9 matches, which, actually, is the lowest number of conceded goals in the entire pro Bundesliga.

Wolfsburg, on the other hand, lost to Nürnberg 1:2 on Saturday. After 9 matches, they have 10 points (3-1-5) and are in 13th place. The defense has conceded 16 goals, on par with 15th place Schalke, and better than Bremen (18 goals, 8th place), Stuttgart (17, 14th), K'lautern (17, 15th), Gladbach (27!, 17th), Köln (17, 18th). Apparently, last year's Wolves had some issues with their defense, so Dieter Hoeneß (Uli of FC Bayern's brother) went out and bought some defensive players, including young Danish international Simon Kjaer and German international Arne Friedrich. Unfortunately, Arne hasn't been able to play this season thanks to a back injury, but he hopes to be back for the second half of the season. Adding to the defensive woes is the injury of goalkeeper Diego Benaglio (Swiss international). The team doesn't seem to have gelled yet, especially the defense. After the match, striker/captain Edin Dzeko expressed his frustration, stating that "we're not playing as a team." I get that sense from watching them on the field, myself.

Writing
I'm still in chapter 1 on revisions. It's been difficult to concentrate at times, and the ringing in my ears doesn't help. I'm going to use November's NaNoWriMo as motivation. I'm not participating, but I'll be using the framework to motivate myself to finish these revisions. I need deadlines to get things done.

To be addressed in a separate post
Sanity/Fear rally plans!

Nausea's back. Breakfast this morning was 8 mg ondansetron, my Synthroid, my omeprazole, and a can of ginger ale.

I haven't decided which doctor to call first: my GP, my GI, or pestering the neuro people to see if they have any info on me at all.

I'm feeling somewhat better than an hour and a half ago, but the idea of food makes me want to gag.

I plan to go to Pilates class, but I won't decide until 8:45 (class is at 9). If I go to class, I'll call a doctor when I get back. If I don't go because I feel ill, I'll call a doctor then.

Dr. Bishop pére took x-rays of my upper gums and didn't see anything. He poked around my tooth and had me bite down, and it didn't hurt. He did notice that the metal filling isn't in the best shape in the world, so if Tuesday's CT doesn't show anything wrong with my sinuses, I should call them back and they'll take the old filling out and look around to see if there are any cracks or the root is damaged, and if not, they'll put a resin filling in. He'd rather avoid doing a root canal if it isn't necessary, and he thinks sinuses is more likely.

The red, painful spot on my gum is a torus, or a bone spur on the gums. I have them on the lower jaw, so it makes sense. Apparently they're related to grinding your teeth, according to one dentistry website that turned up on the internets.

(Oh, yeah, this morning I got a call from the ENT's office with my CT appointment, Tuesday morning. I guess they showed enough evidence to BCBS to get them to authorize it.)

Either I missed the memo or someone failed to deliver it. I should have called an ENT *already* or something. :P

Got a name & number for a practice in Chapel Hill. Left them a message saying my PCP had referred me to them for sinus issues >3 months, I have Blue Cross, and do you need a referral paper from my PCP? With my number to call me back. That was about 20 minutes ago. It's Friday afternoon, though, so I won't be surprised if I don't hear back until Monday.

I can feel the congestionish stuff in my ears, but I don't want to take Mucinex before going out to dinner tonight. I don't want to be sick for Ben's birthday dinner (& drinks).

I have another prescription for Zofran, though, so I can manage the nausea again once I start the expectorant again, whenever that may be.

I think the Mucinex is working. I'll spare you the details.

I'm also increasingly certain that my nausea in weeks past was related to sinus drainage, because I couldn't eat breakfast this morning. One bite of my cereal (delicious cereal ;_; which I had to throw out) was more than enough.

Hopefully I'll be able to eat something sooner than later.

I finished Z-pak #2 on Friday. Wednesday I had a shift of congestion into my nose itself (like a cold, kind of), but by Friday, I felt pretty good.

Saturday midday I felt more congested, and yesterday my voice sounded all nasal, and I started coughing. Today I have congestion, my ears itch, and I'm still coughing.

My doctor's office is going to call me back and let me know if I should pick up the Z-pak refill my dr wrote last week or if we should pursue other options (like a fine needle aspirate of my sinuses to see what's growing there, or a head CT to see where the infection is based [and make sure it's not osteomyelitis or meningitis or an infection of the ocular orbit], or just a stronger antibiotic).

I don't care, really, as long as I can drink beer by October 9.